# BRUCE R CARLYON DDS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Carlyon Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942819420
- **Authorized official:** DR. BRUCE R CARLYON DDS (OWNER)
- **Authorized official phone:** (906) 786-3891

## Contact information

- **Practice address:** 1106 1ST AVE S, ESCANABA, MI 49829-3411
- **Practice address phone:** (906) 786-3891
- **Practice address fax:** (906) 786-3829
- **Mailing address:** 1106 1ST AVE S, ESCANABA, MI 49829-3411
- **Mailing address phone:** (906) 786-3891

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 07/30/2020
- **Last updated:** 07/30/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1003279100 | — | MI |
| 05 | — | 1043310113 | — | MI |