Provider Demographics
NPI:1861035271
Name:BRIAN L PRINS DMD PC
Entity Type:Organization
Organization Name:BRIAN L PRINS DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:PRINS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-773-5441
Mailing Address - Street 1:1390 OLEANDER ST STE A
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-5448
Mailing Address - Country:US
Mailing Address - Phone:541-773-5441
Mailing Address - Fax:
Practice Address - Street 1:1390 OLEANDER ST STE A
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-5448
Practice Address - Country:US
Practice Address - Phone:541-773-5441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty