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Provider Information for 1477874915



DR. JOSHUA DANIEL BRUCE JOSHUA BRUCE

Other Name:   JOSHUA BRUCE
Gender: MALE

Individual NPI: 1477874915

Calendar   Last Updated:  2010-06-23
  Certification Date: 

Details

Name Value
NPI 1477874915
Enumeration Date 2010-06-18
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 936 HOLLY DR
MIDWEST CITY, OK 73110-7309
United States

Phone: 405-269-6921 | Fax:
View Map External Link
Primary Practice Address 1201 N STONEWALL AVE
OKLAHOMA CITY, OK 73117-1214
United States

Phone: 405-269-6921 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 122300000X - Dentist OK 6185