Healthcare Provider Details

I. General information

NPI: 1255516035
Provider Name (Legal Business Name): ROBERT B. BRYAN II, DDS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2007
Last Update Date: 12/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 MCAULEY BLVD
OKLAHOMA CITY OK
73120-8386
US

IV. Provider business mailing address

4320 MCAULEY BLVD
OKLAHOMA CITY OK
73120-8386
US

V. Phone/Fax

Practice location:
  • Phone: 405-755-4826
  • Fax:
Mailing address:
  • Phone: 405-755-4826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number135
License Number StateOK

VIII. Authorized Official

Name: DR. ROBERT BRUCE BRYAN II
Title or Position: MANAGER
Credential: D.D.S.
Phone: 405-755-4826