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General NPI Number Information
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NPI Number | 1063150829
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Entity Type | Organization
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Legal Business Name | BRADFORD G RICE, SR, DDS, PLC
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Dates
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Enumeration Date | 05/23/2022
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Last Update Date | 05/23/2022
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Provider Practice Location Address
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Address Line | 7461 S STATE RD STE A
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City | GOODRICH
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State | MI
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Zip | 48438-9060
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Country | US
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Telephone | 810-636-2265
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Fax |
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Provider Business Mailing Address
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Address Line | 7461 S STATE RD STE A
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City | GOODRICH
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State | MI
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Zip | 48438-9060
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Country | US
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Telephone | 810-636-2265
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Fax |
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Authorized Official
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Title or Position | MANAGER/AGENT
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Name | BRADFORD G RICE SR.
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Credential | DDS
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Telephone | 810-636-2265
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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