Healthcare Provider Details

I. General information

NPI: 1083728968
Provider Name (Legal Business Name): JOHN WEST BRYSON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 HOFF ST,BLDG 9240 USA DENTAL ACTIVITY
FORT BENNING GA
31905
US

IV. Provider business mailing address

4 TRAPPER CT
MIDLAND GA
31820-3807
US

V. Phone/Fax

Practice location:
  • Phone: 706-544-4530
  • Fax: 706-544-1933
Mailing address:
  • Phone: 706-544-4530
  • Fax: 706-544-1933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN009620
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN009620
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: