Provider Demographics
NPI:1861165987
Name:BRICE, HOUSTON (DMD)
Entity type:Individual
Prefix:
First Name:HOUSTON
Middle Name:
Last Name:BRICE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 DAYLILY BLVD
Mailing Address - Street 2:
Mailing Address - City:NOKOMIS
Mailing Address - State:FL
Mailing Address - Zip Code:34275-1761
Mailing Address - Country:US
Mailing Address - Phone:678-761-7684
Mailing Address - Fax:
Practice Address - Street 1:1515 TAMIAMI TRL S STE 3
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-5557
Practice Address - Country:US
Practice Address - Phone:678-761-7684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2023-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1224451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice