Individual
DR. BRUCE ENRIQUE IMBACUAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
14805 DETROIT AVE STE 515, LAKEWOOD, OH 44107-3921
(216) 521-3510
Mailing address
3659 W 128TH ST, CLEVELAND, OH 44111-4524
(216) 618-1742
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
30.027827
OH
1223G0001X
General Practice Dentistry
30.027827
OH
Other
Enumeration date
06/17/2025
Last updated
06/17/2025
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