Provider Demographics
NPI:1104092931
Name:WILLIAM S. BRICKER DDS, INC.
Entity type:Organization
Organization Name:WILLIAM S. BRICKER DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:BRICKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:419-258-6511
Mailing Address - Street 1:PO BOX 1107
Mailing Address - Street 2:
Mailing Address - City:ANTWERP
Mailing Address - State:OH
Mailing Address - Zip Code:45813-1107
Mailing Address - Country:US
Mailing Address - Phone:419-258-6511
Mailing Address - Fax:419-399-2884
Practice Address - Street 1:302 S CLEVELAND STREET
Practice Address - Street 2:
Practice Address - City:ANTWERP
Practice Address - State:OH
Practice Address - Zip Code:45813
Practice Address - Country:US
Practice Address - Phone:419-258-6511
Practice Address - Fax:419-399-2884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300124131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0974138Medicaid