Provider Demographics
NPI:1720347677
Name:GROSSMAN, BRIENNE NICOLE (DDS)
Entity Type:Individual
Prefix:
First Name:BRIENNE
Middle Name:NICOLE
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 W 45TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6265
Mailing Address - Country:US
Mailing Address - Phone:605-338-9242
Mailing Address - Fax:
Practice Address - Street 1:2001 W 45TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-6265
Practice Address - Country:US
Practice Address - Phone:605-338-9242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-13
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD09831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice