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General NPI Number Information
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NPI Number | 1710122403
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Entity Type | Organization
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Legal Business Name | REBECCA C. BRYAN D.D.S.,P. A.
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Dates
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Enumeration Date | 12/09/2008
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Last Update Date | 12/09/2008
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Provider Practice Location Address
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Address Line | 1001 SE 28TH ST STE 7
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City | BENTONVILLE
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State | AR
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Zip | 72712-3206
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Country | US
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Telephone | 479-271-9900
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Fax | 479-271-8290
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Provider Business Mailing Address
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Address Line | 1001 SE 28TH ST STE 7
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City | BENTONVILLE
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State | AR
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Zip | 72712-3206
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Country | US
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Telephone | 479-271-9900
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Fax | 479-271-8290
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Authorized Official
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Title or Position | DOCTOR
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Name | REBECCA C. BRYAN
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Credential | D.D.S.,P.A.
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Telephone | 479-271-9900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3286
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License Number State | AR
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