Provider Demographics
NPI:1902048861
Name:DEVIN M BRICE DMD PC
Entity Type:Organization
Organization Name:DEVIN M BRICE DMD PC
Other - Org Name:ABOVE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:L
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-756-7568
Mailing Address - Street 1:2070 VIRGINIA AVENUE
Mailing Address - Street 2:2070 VIRGINIA AVENUE
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459
Mailing Address - Country:US
Mailing Address - Phone:541-756-7568
Mailing Address - Fax:541-756-0760
Practice Address - Street 1:2070 VIRGINIA AVENUE
Practice Address - Street 2:2070 VIRGINIA AVENUE
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459
Practice Address - Country:US
Practice Address - Phone:541-756-7568
Practice Address - Fax:541-756-0760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-24
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9150261QD0000X
261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental