Provider Demographics
NPI:1447677083
Name:STRAUB-BRUCE, LINDA (RDH, BSED, PHDHP)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:
Last Name:STRAUB-BRUCE
Suffix:
Gender:F
Credentials:RDH, BSED, PHDHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5158 PEACH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-2489
Mailing Address - Country:US
Mailing Address - Phone:814-868-3647
Mailing Address - Fax:
Practice Address - Street 1:5158 PEACH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-2489
Practice Address - Country:US
Practice Address - Phone:814-868-3647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-20
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH-009719-L124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist