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General NPI Number Information
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NPI Number | 1568589778
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Entity Type | Organization
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Legal Business Name | GARY G BRYAN DMD PA
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 03/25/2013
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Provider Practice Location Address
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Address Line | 2038 NC 345 HIGHWAY SOUTH
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City | WANCHESE
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State | NC
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Zip | 27981
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Country | US
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Telephone | 252-473-5774
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2059
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City | MONTEO
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State | NC
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Zip | 27954
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Country | US
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Telephone | 252-473-5774
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Fax | 252-473-3871
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Authorized Official
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Title or Position | DENTIST
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Name | DR. GARY GORDON BRYAN
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Credential | DMD PA
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Telephone | 252-473-5774
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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 | 5269
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License Number State | NC
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