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Organization
DONALD J. BROCKRIEDE, D.D.S., P.C.
Active
Organization
DONALD J. BROCKRIEDE, D.D.S., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DONALD JOE BROCKRIEDE D.D.S. (OFFICER)
(810) 688-3008
Entity
Organization
Contact information
Practice address
3720 HURON ST, NORTH BRANCH, MI 48461-8117
(810) 688-3008
(810) 688-2429
Mailing address
PO BOX 707, NORTH BRANCH, MI 48461-0707
(810) 688-3008
(810) 688-2429
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
2901010543
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5446023
BCBS MEDICAL PROVIDER
MI
01
—
D105430
BCBS OF MICH. DENTAL PROV
MI
Enumeration date
05/03/2007
Last updated
08/22/2020
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