Provider Demographics
NPI:1780857300
Name:RICE, BRADFORD G (DDS)
Entity Type:Individual
Prefix:
First Name:BRADFORD
Middle Name:G
Last Name:RICE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7461 S. STATE RD.
Mailing Address - Street 2:
Mailing Address - City:GOODRICH
Mailing Address - State:MI
Mailing Address - Zip Code:48438
Mailing Address - Country:US
Mailing Address - Phone:810-636-2265
Mailing Address - Fax:810-636-3547
Practice Address - Street 1:7461 S. STATE RD.
Practice Address - Street 2:
Practice Address - City:GOODRICH
Practice Address - State:MI
Practice Address - Zip Code:48438
Practice Address - Country:US
Practice Address - Phone:810-636-2265
Practice Address - Fax:810-636-3547
Is Sole Proprietor?:No
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI131941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice