Healthcare Provider Details

I. General information

NPI: 1588674808
Provider Name (Legal Business Name): BRYANT AND JUNGE PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 OLIVE WAY SUITE 1438
SEATTLE WA
98101
US

IV. Provider business mailing address

509 OLIVE WAY SUITE 1438
SEATTLE WA
98101
US

V. Phone/Fax

Practice location:
  • Phone: 206-682-3383
  • Fax: 206-467-8160
Mailing address:
  • Phone: 206-682-3383
  • Fax: 206-467-8160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number4861
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number9541
License Number StateWA

VIII. Authorized Official

Name: DR. RONALD A BRYANT
Title or Position: DENTIST PROSTHODENTIST
Credential: DDS MSD
Phone: 206-682-3383