Provider Demographics
NPI:1912511361
Name:BRICKELL DENTISTRY PA
Entity Type:Organization
Organization Name:BRICKELL DENTISTRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:GRIDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-968-0155
Mailing Address - Street 1:444 BRICKELL AVE STE 48
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-2403
Mailing Address - Country:US
Mailing Address - Phone:305-371-6040
Mailing Address - Fax:
Practice Address - Street 1:444 BRICKELL AVE STE 48
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-2403
Practice Address - Country:US
Practice Address - Phone:305-371-6040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental