| Bruce B. Wiland, Dds, Msd | |
|
3415 S Lafountain St Ste K Kokomo IN 46902-3827 | |
| (765) 864-0700 | |
| Not Available |
| Full Name | Bruce B. Wiland, Dds, Msd |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 3415 S Lafountain St Ste K, Kokomo, Indiana |
| Authorized Official Name and Position | Bruce Wiland (OWNER) |
| Authorized Official Contact | 7658640700 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bruce B. Wiland, Dds, Msd 3415 S Lafountain St Ste K Kokomo IN 46902-3827 Ph: (765) 864-0700 | Bruce B. Wiland, Dds, Msd 3415 S Lafountain St Ste K Kokomo IN 46902-3827 Ph: (765) 864-0700 |
| NPI Number | 1366697070 |
|---|---|
| Provider Enumeration Date | 11/21/2008 |
| Last Update Date | 11/21/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366697070 | NPI | - | NPPES |
| 100132270 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | 12008945 (Indiana) | Primary |
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