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General NPI Number Information
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NPI Number | 1023318201
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Entity Type | Organization
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Legal Business Name | JAMES G BRYANT DMD
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Dates
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Enumeration Date | 10/22/2010
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Last Update Date | 10/22/2010
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Provider Practice Location Address
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Address Line | 5000 HAMPTON CTR STE 1
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City | MORGANTOWN
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State | WV
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Zip | 26505-1709
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Country | US
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Telephone | 304-598-2012
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Fax | 304-598-2018
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Provider Business Mailing Address
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Address Line | 5000 HAMPTON CTR STE 1
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City | MORGANTOWN
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State | WV
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Zip | 26505-1709
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Country | US
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Telephone | 304-598-2012
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Fax | 304-598-2018
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES GREGORY BRYANT
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Credential | DMD
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Telephone | 304-598-2012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 3341
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License Number State | WV
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