Provider Demographics
NPI:1194856351
Name:PIERCE, BRENDA R (DDS)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:R
Last Name:PIERCE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 JEFFERSON BOULVARD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-1053
Mailing Address - Country:US
Mailing Address - Phone:401-781-2742
Mailing Address - Fax:401-781-2740
Practice Address - Street 1:67 JEFFERSON BOULVARD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-1053
Practice Address - Country:US
Practice Address - Phone:401-781-2742
Practice Address - Fax:401-781-2740
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN025561223P0300X
MADN189481223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIDEN 02556OtherSTATE DENTAL LIC
MADN18948OtherSTATE DENTAL LIC