Provider Demographics
NPI:1225115900
Name:DRS NEVINS FAMILY DENTISTRY PC
Entity Type:Organization
Organization Name:DRS NEVINS FAMILY DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:NEVINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:231-832-5621
Mailing Address - Street 1:1419 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-8688
Mailing Address - Country:US
Mailing Address - Phone:231-796-4409
Mailing Address - Fax:231-796-2694
Practice Address - Street 1:1419 N. STATE ST.
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-9749
Practice Address - Country:US
Practice Address - Phone:231-796-4409
Practice Address - Fax:231-796-2694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI16241122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty