Healthcare Provider Details

I. General information

NPI: 1942203021
Provider Name (Legal Business Name): BRICE GREENE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 N BROADWAY ST
SPRING VALLEY MN
55975-1226
US

IV. Provider business mailing address

220 N BROADWAY ST
SPRING VALLEY MN
55975-1226
US

V. Phone/Fax

Practice location:
  • Phone: 507-346-7752
  • Fax:
Mailing address:
  • Phone: 507-346-7752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8953
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: