Healthcare Provider Details

I. General information

NPI: 1790875854
Provider Name (Legal Business Name): MIRLINA E BRYANT DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIRLINA E HILAIRE DMD

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10901 LITTLE PATUXENT PARKWAY
COLUMBIA MD
21044-2104
US

IV. Provider business mailing address

10901 LITTLE PATUXENT PKWY, HSB 312
COLUMBIA MD
21044-3197
US

V. Phone/Fax

Practice location:
  • Phone: 443-518-1570
  • Fax:
Mailing address:
  • Phone: 443-518-4985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN1000766
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number21149
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14144
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: