Healthcare Provider Details

I. General information

NPI: 1508073735
Provider Name (Legal Business Name): BRUCE A IVERSON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W CROSS DR SUITE 603
LITTLETON CO
80123
US

IV. Provider business mailing address

9200 W CROSS DR SUITE 603
LITTLETON CO
80123
US

V. Phone/Fax

Practice location:
  • Phone: 303-932-7458
  • Fax: 303-932-7460
Mailing address:
  • Phone: 303-932-7458
  • Fax: 303-932-7460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number6978
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: