Healthcare Provider Details

I. General information

NPI: 1417019910
Provider Name (Legal Business Name): CHRISTOPHER M BRIEDEN D.D.S.,M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35050 23 MILE RD
NEW BALTIMORE MI
48047-3606
US

IV. Provider business mailing address

300 S RIVERSIDE AVE
SAINT CLAIR MI
48079-5386
US

V. Phone/Fax

Practice location:
  • Phone: 586-725-4411
  • Fax: 586-725-4431
Mailing address:
  • Phone: 586-329-6671
  • Fax: 586-725-4431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2901012180
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: