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General NPI Number Information
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NPI Number | 1194194431
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Entity Type | Individual
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Provider Name | BRYAN PACKARD
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Gender | Male
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Dates
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Enumeration Date | 09/16/2015
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 343 WARRIOR RD BLDG 2115
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City | FORT STEWART
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State | GA
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Zip | 31314
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Country | US
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Telephone | 912-767-4440
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Fax |
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Provider Business Mailing Address
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Address Line | 35 CONCORDIA DR
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City | SAVANNAH
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State | GA
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Zip | 31419-6228
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Country | US
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Telephone | 270-792-5530
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN015155
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019.030304
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License Number State | IL
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