Bruce Holmstrom D.D.S.,SC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5002167-015 Issued in WI

Legal business name

BRUCE HOLMSTROM D.D.S.,SC

Practice address

5150 N Port Washington Rd
Suite 201
Glendale, WI 53217-5474

Phone

(414) 964-8850

Fax

(414) 964-8918

NPI assigned

Sep 1, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Bruce E Holmstrom, D.D.S

Title

Owner

Phone

(414) 964-8850

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1114029048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5150 N PORT WASHINGTON RD",
            "address_2": "SUITE 201",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532175474",
            "telephone_number": "414-964-8850",
            "fax_number": "414-964-8918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5150 N PORT WASHINGTON RD",
            "address_2": "SUITE 201",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532175474",
            "telephone_number": "414-964-8850",
            "fax_number": "414-964-8918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRUCE HOLMSTROM D.D.S.,SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HOLMSTROM",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "414-964-8850",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "5002167-015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brew City Dental Care LLC
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• Brown Deer Dental Health Center, SC (Tooth Town Dentistry for Kids)
• Bradley Kyle Brown, LPC
• Danicha S Brown
• Ted Terry Bruce, MSW LICSW
• Timothy Peter Bruce, M.D.
• Jay Bubrick, RPH
• Lauri Rachelle Budzynski, LPC
• Judith E Bulluck, RN

• General Practice Dentistry in Glendale, WI
• Providers in Glendale, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.