MEDICARE: DR. CARLTON JAMES BRUCE DMD

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	122300000X	Dentist	DN1856779	MA
2	122300000X	Dentist	11712	NC

General Provider Information

NPI Number	:	1902203532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLTON JAMES BRUCE DMD

Provider Business Mailing Address
First Line	:	1 NASSAU ST
Second Line	:	UNIT 1509
City	:	BOSTON
State	:	MA
Zip	:	02111-1542
Country	:	US
Telephone Number	:	404-275-1137
Fax Number	:

Provider Business Practice Location Address
First Line	:	298 LINCOLN ST SW
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28025-5469
Country	:	US
Telephone Number	:	704-792-2313
Fax Number	:

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

Provider Enumeration Date	:	11/25/2014
Last Update Date	:	02/20/2020

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