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General NPI Number Information
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NPI Number | 1003050568
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Entity Type | Organization
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Legal Business Name | G. THOMAS BRYCE, JR., DDS PA
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Dates
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Enumeration Date | 04/28/2009
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Last Update Date | 04/28/2009
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Provider Practice Location Address
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Address Line | 1509 W PALMETTO ST
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City | FLORENCE
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State | SC
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Zip | 29501-4131
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Country | US
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Telephone | 843-662-8413
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Fax | 843-662-2672
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Provider Business Mailing Address
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Address Line | 1509 W PALMETTO ST
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City | FLORENCE
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State | SC
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Zip | 29501-4131
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Country | US
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Telephone | 843-662-8413
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Fax | 843-662-2672
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Authorized Official
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Title or Position | OWNER
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Name | DR. GORDON THOMAS BRYCE JR.
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Credential | DDS
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Telephone | 843-662-8413
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 1217
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License Number State | SC
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