Healthcare Provider Details

I. General information

NPI: 1780857300
Provider Name (Legal Business Name): BRADFORD G RICE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2008
Last Update Date: 04/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7461 S. STATE RD.
GOODRICH MI
48438
US

IV. Provider business mailing address

7461 S. STATE RD.
GOODRICH MI
48438
US

V. Phone/Fax

Practice location:
  • Phone: 810-636-2265
  • Fax: 810-636-3547
Mailing address:
  • Phone: 810-636-2265
  • Fax: 810-636-3547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number13194
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: