Healthcare Provider Details

I. General information

NPI: 1023318201
Provider Name (Legal Business Name): JAMES G BRYANT DMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2010
Last Update Date: 10/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 HAMPTON CTR STE 1
MORGANTOWN WV
26505-1709
US

IV. Provider business mailing address

5000 HAMPTON CTR STE 1
MORGANTOWN WV
26505-1709
US

V. Phone/Fax

Practice location:
  • Phone: 304-598-2012
  • Fax: 304-598-2018
Mailing address:
  • Phone: 304-598-2012
  • Fax: 304-598-2018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number3341
License Number StateWV

VIII. Authorized Official

Name: DR. JAMES GREGORY BRYANT
Title or Position: OWNER
Credential: DMD
Phone: 304-598-2012