MEDICARE: PATRICK LAWRENCE BRYANT D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	11109	MD

General Provider Information

NPI Number	:	1619058906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK LAWRENCE BRYANT D.D.S

Provider Business Mailing Address
First Line	:	14319 WICKLOW LN
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20707-6887
Country	:	US
Telephone Number	:	301-317-8111
Fax Number	:

Provider Business Practice Location Address
First Line	:	3427 FORT MEADE RD
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20724-2003
Country	:	US
Telephone Number	:	301-776-4600
Fax Number	:	301-776-3649

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	07/08/2007

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