MEDICARE: BRYSON POPP DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	0000011955	TN

General Provider Information

NPI Number	:	1114659802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYSON POPP DDS

Provider Business Mailing Address
First Line	:	4211 HIXSON PIKE
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37415-3113
Country	:	US
Telephone Number	:	423-870-8787
Fax Number	:

Provider Business Practice Location Address
First Line	:	4211 HIXSON PIKE
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37415-3113
Country	:	US
Telephone Number	:	423-870-8787
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2022
Last Update Date	:	07/12/2022

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Directions to “ BRYSON POPP DDS” Practice Location

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