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NPI Code Detail

MEDICARE: DR. BRYAN MICHAEL POPE D.D.S.

MEDICARE: DR. BRYAN MICHAEL POPE D.D.S.
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
1122300000XDentist12095MO

General Provider Information

NPI Number : 1477543965
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRYAN MICHAEL POPE D.D.S.
Provider Business Mailing Address
First Line : 3306 EMERALD LN
Second Line :
City : JEFFERSON CITY
State : MO
Zip : 65109-6877
Country : US
Telephone Number : 573-634-2222
Fax Number :
Provider Business Practice Location Address
First Line : 3306 EMERALD LN
Second Line :
City : JEFFERSON CITY
State : MO
Zip : 65109-6877
Country : US
Telephone Number : 573-634-2222
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2005
Last Update Date : 07/08/2007

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