MEDICARE: DR. BRUCE ALAN CRONHARDT D.M.D.

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
1	1223G0001X	General Practice Dentistry	1811	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255430047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE ALAN CRONHARDT D.M.D.

Provider Business Mailing Address
First Line	:	514 SOUTH STREET
Second Line	:
City	:	BOW
State	:	NH
Zip	:	03304-3411
Country	:	US
Telephone Number	:	603-224-3151
Fax Number	:	603-228-3417

Provider Business Practice Location Address
First Line	:	514 SOUTH STREET
Second Line	:
City	:	BOW
State	:	NH
Zip	:	03304-3411
Country	:	US
Telephone Number	:	603-224-3151
Fax Number	:	603-228-3417

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	07/08/2007

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