Healthcare Provider Details

I. General information

NPI: 1811989403
Provider Name (Legal Business Name): BRUCE F. OKUN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 E SOUTHERN AVE SUITE 8
TEMPE AZ
85282-5403
US

IV. Provider business mailing address

8263 S PECAN GROVE CIR
TEMPE AZ
85284-2311
US

V. Phone/Fax

Practice location:
  • Phone: 480-967-8763
  • Fax: 480-967-6050
Mailing address:
  • Phone: 480-838-6695
  • Fax: 480-967-6050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2015
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: