Individual
DR. GEORGE LYLE BRUCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
BLDG 2441 21ST STREET, USA DENTAC, FORT CAMPBELL, KY 42223-5369
(270) 798-8614
(270) 798-8633
Mailing address
BLDG 2441 21ST STREET, USA DENTAC, FORT CAMPBELL, KY 42223-5369
(270) 798-8614
(270) 798-8633
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
D6469
OR
1223P0221X
Pediatric Dentistry
Primary
D6469
OR
Other
Enumeration date
01/18/2006
Last updated
10/04/2007
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