Healthcare Provider Details

I. General information

NPI: 1770791600
Provider Name (Legal Business Name): BRUCE EVANS TRIPLETT D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 NICKMAN PLAZA
LEMONT FURNACE PA
15456-9732
US

IV. Provider business mailing address

7 NICKMAN PLAZA
LEMONT FURNACE PA
15456-9732
US

V. Phone/Fax

Practice location:
  • Phone: 724-438-0400
  • Fax:
Mailing address:
  • Phone: 724-438-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS024921-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: