MEDICARE: GEORGE H. K. BRYANT DDS INCORPORATED

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	17039	CA

General Provider Information

NPI Number	:	1295853448
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGE H. K. BRYANT DDS INCORPORATED

Provider Business Mailing Address
First Line	:	32341 COAST HWY
Second Line	:
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-6701
Country	:	US
Telephone Number	:	949-499-1351
Fax Number	:	949-499-1611

Provider Business Practice Location Address
First Line	:	32341 COAST HWY
Second Line	:
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-6701
Country	:	US
Telephone Number	:	949-499-1351
Fax Number	:	949-499-1611

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GEORGE HAMILTON KERR BRYANT
Credential	:	D.D.S
Telephone Number	:	949-499-1351

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	08/22/2020

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