Provider Demographics
NPI:1700953767
Name:FLETCHER, BRUCE T (DMD MAGD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:T
Last Name:FLETCHER
Suffix:
Gender:M
Credentials:DMD MAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 LEXINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052-1416
Mailing Address - Country:US
Mailing Address - Phone:860-229-9928
Mailing Address - Fax:860-229-8295
Practice Address - Street 1:49 LEXINGTON STREET
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1416
Practice Address - Country:US
Practice Address - Phone:860-229-9928
Practice Address - Fax:860-229-8295
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4691122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist