George Lyle Bruce, DMD

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

D6469 Issued in OR

Practice address

BLDG 2441 21St Street
USA Dentac
Fort Campbell, KY 42223-5369

Phone

(270) 798-8614

Fax

(270) 798-8633

NPI assigned

Jan 18, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1137542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1191456000000",
    "number": "1154301042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "BLDG 2441 21ST STREET",
            "address_2": "USA DENTAC",
            "city": "FORT CAMPBELL",
            "state": "KY",
            "postal_code": "422235369",
            "telephone_number": "270-798-8614",
            "fax_number": "270-798-8633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BLDG 2441 21ST STREET",
            "address_2": "USA DENTAC",
            "city": "FORT CAMPBELL",
            "state": "KY",
            "postal_code": "422235369",
            "telephone_number": "270-798-8614",
            "fax_number": "270-798-8633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUCE",
        "first_name": "GEORGE",
        "middle_name": "LYLE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-18",
        "last_updated": "2007-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D6469",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "OR",
            "license": "D6469",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laytheater Michelle Brown, NURSE PRACTITIONER
• Matthew Christopher Brown, MD
• Rosanna V Brown, PA
• Wendy D Brown, LPN
• Alma Bruce
• Samuel Paul Brunson
• Travis Robert Bryant, OD
• Alan Daniel Bucholz, PA
• Christina N Buckley, FNP-BC, ENP-C
• Rebecca Lynn Budnick, AU.D.

• Pediatric Dentistry in Fort Campbell, KY
• Providers in Fort Campbell, KY by specialty
• Pediatric Dentistry in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2007; 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.