Provider Demographics
NPI:1164523486
Name:BOYCE, BRADI K (DDS)
Entity Type:Individual
Prefix:
First Name:BRADI
Middle Name:K
Last Name:BOYCE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SEBEWAING
Mailing Address - State:MI
Mailing Address - Zip Code:48759-1568
Mailing Address - Country:US
Mailing Address - Phone:989-883-3530
Mailing Address - Fax:
Practice Address - Street 1:106 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SEBEWAING
Practice Address - State:MI
Practice Address - Zip Code:48759-1568
Practice Address - Country:US
Practice Address - Phone:989-883-3530
Practice Address - Fax:989-883-9131
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010177131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice