Provider Demographics
NPI:1669992749
Name:GRISDELA, BRIAN MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:MICHAEL
Last Name:GRISDELA
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:PO BOX 567
Mailing Address - Street 2:
Mailing Address - City:DIMONDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48821-0567
Mailing Address - Country:US
Mailing Address - Phone:517-646-8226
Mailing Address - Fax:517-646-7545
Practice Address - Street 1:PO BOX 567
Practice Address - Street 2:
Practice Address - City:DIMONDALE
Practice Address - State:MI
Practice Address - Zip Code:48821-0567
Practice Address - Country:US
Practice Address - Phone:517-646-8226
Practice Address - Fax:517-646-7545
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010223671223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice