Provider Demographics
NPI:1497961627
Name:NEVINS, BRYAN EDWARDS (DDS)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:EDWARDS
Last Name:NEVINS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:MR
Other - First Name:BRYAN
Other - Middle Name:
Other - Last Name:NEVINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15460 16 MILE RD
Mailing Address - Street 2:
Mailing Address - City:RODNEY
Mailing Address - State:MI
Mailing Address - Zip Code:49342-9625
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI162411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice