Individual
DR. BRUCE BENNINGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4534 PRECISSI LN, STOCKTON, CA 95207-6213
(209) 478-5167
(209) 478-2313
Mailing address
4534 PRECISSI LN, STOCKTON, CA 95207-6213
(209) 478-5167
(209) 478-2313
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
17238
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
94 2L88487
TAX ID
CA
Enumeration date
03/13/2007
Last updated
07/08/2007
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