Provider Demographics
NPI:1215297361
Name:PRINS, BRIAN L (DMD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:L
Last Name:PRINS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1390 OLEANDER ST STE A
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-5448
Mailing Address - Country:US
Mailing Address - Phone:541-773-5441
Mailing Address - Fax:
Practice Address - Street 1:1390 OLEANDER ST STE A
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-5448
Practice Address - Country:US
Practice Address - Phone:541-773-5441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-23
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9470122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist