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General NPI Number Information
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NPI Number | 1770180622
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Entity Type | Individual
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Provider Name | KEVIN PATRICK BRYANT JR. DMD
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Gender | Male
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Dates
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Enumeration Date | 10/05/2020
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 1001 CARTER ST STE H
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City | CHATTANOOGA
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State | TN
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Zip | 37402-5014
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Country | US
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Telephone | 423-267-1853
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Fax | 423-267-9518
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Provider Business Mailing Address
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Address Line | 1001 CARTER ST STE H
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City | CHATTANOOGA
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State | TN
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Zip | 37402-5014
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Country | US
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Telephone | 232-671-8534
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Fax | 423-267-9518
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 12283
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License Number State | TN
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