Provider Demographics
NPI:1285899484
Name:BRIEDEN, MARK P (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:P
Last Name:BRIEDEN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
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Mailing Address - Street 1:158 MARCELL DR NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-1390
Mailing Address - Country:US
Mailing Address - Phone:616-866-3010
Mailing Address - Fax:616-866-7401
Practice Address - Street 1:158 MARCELL DR NE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-1390
Practice Address - Country:US
Practice Address - Phone:616-866-3010
Practice Address - Fax:616-866-7401
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMI 0319501223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics