Provider Demographics
NPI:1831264811
Name:SCHWARTZ, BRUCE DAVID (DDS)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:DAVID
Last Name:SCHWARTZ
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 1:34950 CHARDON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WILLOUGHBY HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44094
Mailing Address - Country:US
Mailing Address - Phone:440-510-2424
Mailing Address - Fax:440-510-1515
Practice Address - Street 1:34950 CHARDON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WILLOUGHBY HILLS
Practice Address - State:OH
Practice Address - Zip Code:44094
Practice Address - Country:US
Practice Address - Phone:440-510-2424
Practice Address - Fax:440-510-1515
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH147151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0279283Medicaid