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General NPI Number Information
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NPI Number | 1548482987
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Entity Type | Organization
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Legal Business Name | BRYANT DENTAL CARE
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 59 DAVENPORT ST
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City | AUGUSTA
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State | ME
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Zip | 04330-5812
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Country | US
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Telephone | 207-621-1111
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Fax | 207-621-1119
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Provider Business Mailing Address
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Address Line | 59 DAVENPORT ST
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City | AUGUSTA
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State | ME
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Zip | 04330-5812
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Country | US
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Telephone | 207-621-1111
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Fax | 207-621-1119
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Authorized Official
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Title or Position | OFFICE COORDINATOR
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Name | MS. BRENDA C. AMES
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Credential |
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Telephone | 207-621-1111
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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 | 2723
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License Number State | ME
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