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General NPI Number Information
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NPI Number | 1316082159
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Entity Type | Individual
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Provider Name | GREGORY LEE BRYAN D.D.S
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Gender | Male
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 10120 S EASTERN AVE SUITE 345
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City | HENDERSON
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State | NV
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Zip | 89052-3951
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Country | US
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Telephone | 702-616-1920
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Fax | 702-454-4716
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Provider Business Mailing Address
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Address Line | 10120 S EASTERN AVE SUITE 345
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City | HENDERSON
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State | NV
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Zip | 89052-3951
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Country | US
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Telephone | 702-616-1920
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Fax | 702-454-4716
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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 | NV2214
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License Number State | NV
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