MEDICARE: DR. BRUCE MARTIN MENEES JR. 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
1	122300000X	Dentist	2260	AR

General Provider Information

NPI Number	:	1942368220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE MARTIN MENEES JR. DDS

Provider Business Mailing Address
First Line	:	1808 N TAYLOR ST
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72207-4625
Country	:	US
Telephone Number	:	501-664-2217
Fax Number	:	501-664-2220

Provider Business Practice Location Address
First Line	:	1808 N TAYLOR ST
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72207-4625
Country	:	US
Telephone Number	:	501-664-2217
Fax Number	:	501-664-2220

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	07/08/2007

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