Provider Demographics
NPI:1801001433
Name:C. A. 'BUDDY' BRICE, III, D.D.S.P.A.
Entity Type:Organization
Organization Name:C. A. 'BUDDY' BRICE, III, D.D.S.P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRICE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:228-374-8175
Mailing Address - Street 1:1070 JUDGE SEKUL AVE
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39530-2908
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1070 JUDGE SEKUL AVE
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39530-2908
Practice Address - Country:US
Practice Address - Phone:228-374-8175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1795-781223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty