Provider Demographics
NPI:1356428510
Name:AAHRENS, BRUCE THOMAS (DDS)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:THOMAS
Last Name:AAHRENS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:BRUCE
Other - Middle Name:HENRY
Other - Last Name:THOMAS
Other - Suffix:II
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3121 W CASINO AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-5892
Mailing Address - Country:US
Mailing Address - Phone:623-210-2719
Mailing Address - Fax:623-773-1831
Practice Address - Street 1:7616 W THUNDERBIRD RD
Practice Address - Street 2:SUITE 1
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-6081
Practice Address - Country:US
Practice Address - Phone:623-979-6800
Practice Address - Fax:623-773-1831
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ52281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice