Provider Demographics
NPI:1619317039
Name:EIDSON, BRITTANY KY (DDS, FACS)
Entity Type:Individual
Prefix:DR
First Name:BRITTANY
Middle Name:KY
Last Name:EIDSON
Suffix:
Gender:F
Credentials:DDS, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6255 GRAND RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-5323
Mailing Address - Country:US
Mailing Address - Phone:810-522-4001
Mailing Address - Fax:
Practice Address - Street 1:6255 GRAND RIVER RD
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-5323
Practice Address - Country:US
Practice Address - Phone:810-522-4001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-29
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA14014177711223S0112X
MI29016007311223S0112X, 204E00000X
PADS0395601223S0112X
TX346991223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery