Healthcare Provider Details

I. General information

NPI: 1538176888
Provider Name (Legal Business Name): NILS R BRYANT DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 US HIGHWAY 206 SUITE 1
FLANDERS NJ
07836-9189
US

IV. Provider business mailing address

230 US HIGHWAY 206 SUITE 1
FLANDERS NJ
07836-9189
US

V. Phone/Fax

Practice location:
  • Phone: 973-927-9268
  • Fax: 973-927-8984
Mailing address:
  • Phone: 973-927-9268
  • Fax: 973-927-8984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDI20002
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: