Provider Demographics
NPI:1033252705
Name:BRIAN G. CRISS
Entity Type:Organization
Organization Name:BRIAN G. CRISS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:CRISS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-342-6652
Mailing Address - Street 1:720 SHERIDAN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-2407
Mailing Address - Country:US
Mailing Address - Phone:605-342-6652
Mailing Address - Fax:605-342-6656
Practice Address - Street 1:720 SHERIDAN LAKE RD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-2407
Practice Address - Country:US
Practice Address - Phone:605-342-6652
Practice Address - Fax:605-342-6656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM8511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1881601441OtherNPI
SD715225OtherUNITED CONCORDIA