Healthcare Provider Details

I. General information

NPI: 1326122797
Provider Name (Legal Business Name): JAMES GREGORY BRYANT DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 HAMPTON CENTER SUITE 1
MORGANTOWN WV
26505
US

IV. Provider business mailing address

5000 HAMPTON CENTER SUITE 1
MORGANTOWN WV
26505
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 NumberW3341
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: