Basic Information
Provider Information
NPI: 1346362514
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HESSEL
FirstName: BRUCE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DDS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 3189
Address2:  
City: SYRACUSE
State: NY
PostalCode: 132203189
CountryCode: US
TelephoneNumber: 3154546000
FaxNumber: 3154548650
Practice Location
Address1: 319 S CEDAR CREST BLVD
Address2:  
City: ALLENTOWN
State: PA
PostalCode: 181033600
CountryCode: US
TelephoneNumber: 6105307785
FaxNumber: 4842231898
Other Information
ProviderEnumerationDate: 04/06/2007
LastUpdateDate: 02/08/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000XDS020915LPAY Dental ProvidersDentist 

No ID Information.


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