Provider Demographics
NPI:1538424486
Name:BRUMM, BRUCE ROBERT (DDS)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ROBERT
Last Name:BRUMM
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 1:775 ACADEMY DR
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-2031
Mailing Address - Country:US
Mailing Address - Phone:858-755-2233
Mailing Address - Fax:858-755-7001
Practice Address - Street 1:775 ACADEMY DR
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-2031
Practice Address - Country:US
Practice Address - Phone:858-755-2233
Practice Address - Fax:858-755-7001
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-06
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADB035476122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist