MEDICARE: DR. BRUCE F. OKUN D.D.S.

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	2015	AZ

General Provider Information

NPI Number	:	1811989403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE F. OKUN D.D.S.

Provider Business Mailing Address
First Line	:	8263 S PECAN GROVE CIR
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85284-2311
Country	:	US
Telephone Number	:	480-838-6695
Fax Number	:	480-967-6050

Provider Business Practice Location Address
First Line	:	1050 E SOUTHERN AVE
Second Line	:	SUITE 8
City	:	TEMPE
State	:	AZ
Zip	:	85282-5403
Country	:	US
Telephone Number	:	480-967-8763
Fax Number	:	480-967-6050

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

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	07/08/2007

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