Healthcare Provider Details

I. General information

NPI: 1144248931
Provider Name (Legal Business Name): BRYAN GRZYWACZ DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37734 VAN DYKE AVE
STERLING HEIGHTS MI
48312-1839
US

IV. Provider business mailing address

5050 SCHAEFER RD
DEARBORN MI
48126-3249
US

V. Phone/Fax

Practice location:
  • Phone: 586-978-2100
  • Fax: 586-978-7244
Mailing address:
  • Phone: 313-582-8150
  • Fax: 313-582-6015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901017168
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: