Provider Demographics
NPI:1548341431
Name:BRUECKHEIMER, WILLIAM R JR (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:R
Last Name:BRUECKHEIMER
Suffix:JR
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 1:2027 THOMASVILLE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-0773
Mailing Address - Country:US
Mailing Address - Phone:850-385-7405
Mailing Address - Fax:850-385-9230
Practice Address - Street 1:2027 THOMASVILLE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-0773
Practice Address - Country:US
Practice Address - Phone:850-385-7405
Practice Address - Fax:850-385-9230
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0006735122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist