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1770180622 NPI number — KEVIN PATRICK BRYANT JR. DMD

NPI Number: 1770180622
Health Care Provider/Practitioner: KEVIN PATRICK BRYANT JR. DMD

Information about “1770180622” NPI (KEVIN PATRICK BRYANT JR. DMD) exists in 1770180622 in HTML format HTML  |  1770180622 in plain Text format TXT  |  1770180622 in PDF (Portable Document Format) PDF  |  1770180622 in an XML format XML  formats.

NPI Number : 1770180622 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1770180622",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BRYANT",
    "FirstName": "KEVIN",
    "MiddleName": "PATRICK",
    "NamePrefix": "DR.",
    "NameSuffix": "JR.",
    "Credential": "DMD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1001 CARTER ST STE H",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHATTANOOGA",
    "MailingAddressStateName": "TN",
    "MailingAddressPostalCode": "37402-5014",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "232-671-8534",
    "MailingAddressFaxNumber": "423-267-9518",
    "FirstLinePracticeLocationAddress": "1001 CARTER ST STE H",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHATTANOOGA",
    "PracticeLocationAddressStateName": "TN",
    "PracticeLocationAddressPostalCode": "37402-5014",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "423-267-1853",
    "PracticeLocationAddressFaxNumber": "423-267-9518",
    "EnumerationDate": "10/05/2020",
    "LastUpdateDate": "02/12/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "390200000X",
          "TaxonomyName": "Student in an Organized Health Care Education/Training Program",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1223E0200X",
          "TaxonomyName": "Endodontics",
          "LicenseNumber": "12283",
          "LicenseNumberStateCode": "TN",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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