Healthcare Provider Details

I. General information

NPI: 1609027903
Provider Name (Legal Business Name): BRUCE DOW, D.D.S., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2008
Last Update Date: 10/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 SOUTH C STREET
HAWTHORNE NV
89415-2507
US

IV. Provider business mailing address

155 SOUTH C STREET
HAWTHORNE NV
89415-2507
US

V. Phone/Fax

Practice location:
  • Phone: 775-945-2438
  • Fax: 775-945-1348
Mailing address:
  • Phone: 775-945-2438
  • Fax: 775-945-1348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number2137
License Number StateNV

VIII. Authorized Official

Name: DR. BRUCE DOW
Title or Position: PRESIDENT/DENTIST
Credential: DDS
Phone: 775-945-2438