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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