Provider Demographics
NPI:1700930161
Name:MULDER, BRIAN A (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:A
Last Name:MULDER
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 1:2008 EASTCASTLE DR SE STE C
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-8874
Mailing Address - Country:US
Mailing Address - Phone:616-455-8400
Mailing Address - Fax:
Practice Address - Street 1:2008 EASTCASTLE SE
Practice Address - Street 2:SUITE C
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508
Practice Address - Country:US
Practice Address - Phone:616-455-8400
Practice Address - Fax:616-455-4283
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315022676122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist