Provider Demographics
NPI:1356029342
Name:CASEY BRUHN, D.D.S., PC
Entity type:Organization
Organization Name:CASEY BRUHN, D.D.S., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:CASEY
Authorized Official - Last Name:BRUHN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-842-5640
Mailing Address - Street 1:16930 ROBBINS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2784
Mailing Address - Country:US
Mailing Address - Phone:616-842-5640
Mailing Address - Fax:616-842-0055
Practice Address - Street 1:16930 ROBBINS RD STE 100
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2784
Practice Address - Country:US
Practice Address - Phone:616-842-5640
Practice Address - Fax:616-842-0055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental