| Doctor Name: | DR. BRUCE JAY ETKIN |
| NPI Number: | 1629376009 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DDS, CAGS |
| License Number: | 2188 |
| Business Practice Address: | 7181 E Camelback Rd Apt 1201 Scottsdale, AZ - 852511279 |
| Business Phone Number: | 4802238990 |
| Business Fax Number: | 4809912474 |
| Mailing Address: | 7181 E Camelback Rd, Apt 1201 SCOTTSDALE |
| State: | AZ |
| Postal Code: | 852511279 |
| Phone Number: | 4802238990 |
| Fax Number: | 4809912474 |
| NPI Enumeration Date: | 03/08/2011 |
| NPI Last Update Date: | 03/08/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1223P0700X |
| License Number: | 2188 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Dentist |
| Taxonomy Specialization: | Prosthodontics |
| Taxonomy Definition: | That branch of dentistry pertaining to the restoration and maintenance of oral functions, comfort, appearance and health of the patient by the restoration of natural teeth and/or the replacement of missing teeth and contiguous oral and maxillofacial tissues with artificial substitutes. |