Healthcare Provider Details

I. General information

NPI: 1063150829
Provider Name (Legal Business Name): BRADFORD G RICE, SR, DDS, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2022
Last Update Date: 05/23/2022
Certification Date: 05/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7461 S STATE RD STE A
GOODRICH MI
48438-9060
US

IV. Provider business mailing address

7461 S STATE RD STE A
GOODRICH MI
48438-9060
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRADFORD G RICE SR.
Title or Position: MANAGER/AGENT
Credential: DDS
Phone: 810-636-2265