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General NPI Number Information
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NPI Number | 1417002973
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Entity Type | Individual
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Provider Name | BRYANT CORNELIUS DDS, MBA, MPH
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Gender | Male
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 12/18/2019
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Provider Practice Location Address
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Address Line | 260 TOLLGATE RD
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City | ZELIENOPLE
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State | PA
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Zip | 16063-3030
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Country | US
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Telephone | 970-260-8629
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Fax |
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Provider Business Mailing Address
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Address Line | 260 TOLLGATE RD
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City | ZELIENOPLE
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State | PA
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Zip | 16063-3030
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Country | US
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Telephone | 970-260-8629
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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 | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | DS039600
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 30024998
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | 30.024998
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License Number State | OH
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