Provider Demographics
NPI:1912747171
Name:DUNSTAN, BRYCE CHARLES (DDS)
Entity type:Individual
Prefix:DR
First Name:BRYCE
Middle Name:CHARLES
Last Name:DUNSTAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E STATE RD
Mailing Address - Street 2:
Mailing Address - City:GRANT
Mailing Address - State:MI
Mailing Address - Zip Code:49327-9751
Mailing Address - Country:US
Mailing Address - Phone:810-965-8196
Mailing Address - Fax:
Practice Address - Street 1:517 N STONE RD STE 102
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:MI
Practice Address - Zip Code:49412-8629
Practice Address - Country:US
Practice Address - Phone:231-924-5542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901602082122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist