Provider Demographics
NPI:1538162425
Name:POPE, BRUCE M (DDS)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:M
Last Name:POPE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 LARKIN RD
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:CA
Mailing Address - Zip Code:95953-2442
Mailing Address - Country:US
Mailing Address - Phone:530-695-1884
Mailing Address - Fax:530-695-1994
Practice Address - Street 1:9900 LARKIN RD
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:CA
Practice Address - Zip Code:95953-2442
Practice Address - Country:US
Practice Address - Phone:530-695-1884
Practice Address - Fax:530-695-1994
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA294231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice