Healthcare Provider Details

I. General information

NPI: 1861668592
Provider Name (Legal Business Name): DR. BRYAN CHRISTOPHER BUMPAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DR. BRYAN CHRISTOPHER BUMPAS

II. Dates (important events)

Enumeration Date: 05/02/2008
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 NW 192ND ST
EDMOND OK
73012-4031
US

IV. Provider business mailing address

1200 NW 192ND ST
EDMOND OK
73012-4031
US

V. Phone/Fax

Practice location:
  • Phone: 405-282-6444
  • Fax: 405-282-6457
Mailing address:
  • Phone: 405-282-6444
  • Fax: 405-282-6457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberOK5367
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: