Provider Demographics
NPI:1487980421
Name:GOERINGER, BRUCE MORGAN (DDS)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:MORGAN
Last Name:GOERINGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-1213
Mailing Address - Country:US
Mailing Address - Phone:570-675-3646
Mailing Address - Fax:570-674-3994
Practice Address - Street 1:15 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-1213
Practice Address - Country:US
Practice Address - Phone:570-675-3646
Practice Address - Fax:570-674-3994
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSO21194L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist