Provider Demographics
NPI:1073680237
Name:KWAPISZ, BRIAN RAYMOND (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:RAYMOND
Last Name:KWAPISZ
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 1:303 BELVEDERE AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-1451
Mailing Address - Country:US
Mailing Address - Phone:231-547-4148
Mailing Address - Fax:231-547-5670
Practice Address - Street 1:303 BELVEDERE AVE
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720-1451
Practice Address - Country:US
Practice Address - Phone:231-547-4148
Practice Address - Fax:231-547-5670
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901017283122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist