Organization
BRUCE B. WILAND, DDS, MSD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRUCE WILAND DDS, MSD (OWNER)
(765) 864-0700
Entity
Organization
Contact information
Practice address
3415 S LAFOUNTAIN ST STE K, KOKOMO, IN 46902-3827
(765) 864-0700
Mailing address
3415 S LAFOUNTAIN ST STE K, KOKOMO, IN 46902-3827
(765) 864-0700
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
12008945
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100132270
—
IN
Enumeration date
11/21/2008
Last updated
11/21/2008
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