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General NPI Number Information
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NPI Number | 1508845918
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Entity Type | Organization
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Legal Business Name | MARK P. BRIEDEN D.D.S., M.S., P.C.
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Dates
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Enumeration Date | 01/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 158 MARCELL DR NE
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City | ROCKFORD
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State | MI
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Zip | 49341-1390
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Country | US
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Telephone | 616-866-3010
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Fax | 616-866-7401
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Provider Business Mailing Address
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Address Line | 158 MARCELL DR NE
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City | ROCKFORD
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State | MI
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Zip | 49341-1390
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Country | US
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Telephone | 616-866-3010
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Fax | 616-866-7401
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. MARK P. BRIEDEN
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Credential | DDS, MS
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Telephone | 616-866-3010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 031950
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License Number State | MI
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