Provider Demographics
NPI:1063150829
Name:BRADFORD G RICE, SR, DDS, PLC
Entity type:Organization
Organization Name:BRADFORD G RICE, SR, DDS, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/AGENT
Authorized Official - Prefix:
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:G
Authorized Official - Last Name:RICE
Authorized Official - Suffix:SR
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-636-2265
Mailing Address - Street 1:7461 S STATE RD STE A
Mailing Address - Street 2:
Mailing Address - City:GOODRICH
Mailing Address - State:MI
Mailing Address - Zip Code:48438-9060
Mailing Address - Country:US
Mailing Address - Phone:810-636-2265
Mailing Address - Fax:
Practice Address - Street 1:7461 S STATE RD STE A
Practice Address - Street 2:
Practice Address - City:GOODRICH
Practice Address - State:MI
Practice Address - Zip Code:48438-9060
Practice Address - Country:US
Practice Address - Phone:810-636-2265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
1780857300OtherNPPES