Individual
DR. BRUCE STEVEN DODGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
2800 W MAGNOLIA BLVD, BURBANK, CA 91505-3036
(818) 846-9041
(818) 842-4065
Mailing address
1610 ALTA PARK LANE, LA CANADA, CA 91011
(818) 624-9074
(818) 842-4065
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
28436
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
953536282
TAX IDENTIFICATION NUMBER
CA
Enumeration date
08/09/2006
Last updated
07/16/2014
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