Healthcare Provider Details

I. General information

NPI: 1902972706
Provider Name (Legal Business Name): LANORA ELAINE BRYANT DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LANORA MAURICE

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 02/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 N PARKWAY JACKSON MADISON COUNTY REGIONAL HEALTH DEPT
JACKSON TN
38305-3058
US

IV. Provider business mailing address

37 BON AIR CIRCLE
JACKSON TN
38305
US

V. Phone/Fax

Practice location:
  • Phone: 731-423-3020
  • Fax: 731-927-8600
Mailing address:
  • Phone: 731-660-4613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS3606
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: