Provider Demographics
NPI:1679832307
Name:LINDA M BRYCE DDS SC
Entity Type:Organization
Organization Name:LINDA M BRYCE DDS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRYCE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:920-458-3746
Mailing Address - Street 1:1407 N 8TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-3400
Mailing Address - Country:US
Mailing Address - Phone:920-458-3746
Mailing Address - Fax:920-458-8310
Practice Address - Street 1:1407 N 8TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-3400
Practice Address - Country:US
Practice Address - Phone:920-458-3746
Practice Address - Fax:920-458-8310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-15
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI584915122300000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty