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NPI Code Detail

MEDICARE: DR. BRUCE DAVID HUSTAD DDS

MEDICARE: DR. BRUCE DAVID HUSTAD DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry7814MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11008116OTHERMNPREFERRED ONE
241594HUOTHERMNBCBS MN
3HP37187OTHERMNHEALTH PARTNERS
4401549OTHERMNUNITED CONCORDIA

General Provider Information

NPI Number : 1225137805
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRUCE DAVID HUSTAD DDS
Provider Business Mailing Address
First Line : 1225 E 1ST ST
Second Line :
City : DULUTH
State : MN
Zip : 55805-2402
Country : US
Telephone Number : 218-728-6445
Fax Number : 218-724-7003
Provider Business Practice Location Address
First Line : 1225 E 1ST ST
Second Line :
City : DULUTH
State : MN
Zip : 55805-2402
Country : US
Telephone Number : 218-728-6445
Fax Number : 218-724-7003
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2006
Last Update Date : 10/30/2007

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