Provider Demographics
NPI:1851409445
Name:PRINCE, BRIAN CRAIG (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:CRAIG
Last Name:PRINCE
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 1:11101 HEFNER POINTE
Mailing Address - Street 2:STE 100
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120
Mailing Address - Country:US
Mailing Address - Phone:405-749-1588
Mailing Address - Fax:405-749-1438
Practice Address - Street 1:11101 HEFNER POINTE
Practice Address - Street 2:STE 100
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120
Practice Address - Country:US
Practice Address - Phone:405-749-1588
Practice Address - Fax:405-749-1438
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4767122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist