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NPI Code Detail

MEDICARE: BRUCE WAYNE KAUFMAN DDS

MEDICARE: BRUCE WAYNE KAUFMAN 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
1122300000XDentist13324MO

General Provider Information

NPI Number : 1487665477
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRUCE WAYNE KAUFMAN DDS
Provider Business Mailing Address
First Line : 1864 SOUTH KENTWOOD AVENUE
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65804-2323
Country : US
Telephone Number : 417-883-1597
Fax Number : 417-883-1519
Provider Business Practice Location Address
First Line : 1864 SOUTH KENTWOOD AVENUE
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65804-2323
Country : US
Telephone Number : 417-883-1597
Fax Number : 417-883-1519
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2006
Last Update Date : 07/08/2007

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