Healthcare Provider Details

I. General information

NPI: 1801836515
Provider Name (Legal Business Name): CRAIG S BRUCE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 01/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HWY 160 & MP 394.3
KAYENTA AZ
86033
US

IV. Provider business mailing address

PO BOX 368
KAYENTA AZ
86033-0368
US

V. Phone/Fax

Practice location:
  • Phone: 928-697-4000
  • Fax:
Mailing address:
  • Phone: 928-697-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5875
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: