Provider Demographics
NPI:1891304275
Name:OPPS, BRYCE (DMD)
Entity type:Individual
Prefix:
First Name:BRYCE
Middle Name:
Last Name:OPPS
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 1:619 N SEGOE RD APT 309
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-3156
Mailing Address - Country:US
Mailing Address - Phone:608-395-1946
Mailing Address - Fax:
Practice Address - Street 1:390 S GRAND AVE STE 110
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-9294
Practice Address - Country:US
Practice Address - Phone:608-237-1920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1002385-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist