Provider Demographics
NPI:1528279379
Name:BRUCE, SUSANA M (DDS)
Entity type:Individual
Prefix:DR
First Name:SUSANA
Middle Name:M
Last Name:BRUCE
Suffix:
Gender:F
Credentials:DDS
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Mailing Address - Street 1:7531 BRADFORD PEAR DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-8425
Mailing Address - Country:US
Mailing Address - Phone:972-506-7424
Mailing Address - Fax:972-538-3771
Practice Address - Street 1:1005 LONG PRAIRIE RD
Practice Address - Street 2:STE 100
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-4202
Practice Address - Country:US
Practice Address - Phone:972-538-3700
Practice Address - Fax:372-538-3771
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX166881223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics