Provider Demographics
NPI:1134282056
Name:BRUHN II, FREDERICK CASEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:CASEY
Last Name:BRUHN II
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 1:16930 ROBBINS RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2787
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16930 ROBBINS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2787
Practice Address - Country:US
Practice Address - Phone:616-842-5640
Practice Address - Fax:616-842-0055
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI170401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice