Provider Demographics
NPI:1548280910
Name:TOY, BRUCE GORDON (DDS)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:GORDON
Last Name:TOY
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 1:333 SAN CARLOS WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-2056
Mailing Address - Country:US
Mailing Address - Phone:209-478-4322
Mailing Address - Fax:209-478-4117
Practice Address - Street 1:333 SAN CARLOS WAY
Practice Address - Street 2:SUITE A
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-2056
Practice Address - Country:US
Practice Address - Phone:209-478-4322
Practice Address - Fax:209-478-4117
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA301261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93643-01Medicaid