MEDICARE: RACHEL LEIGH BRYANT 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	122300000X	Dentist	DEN.00205988	CO

General Provider Information

NPI Number	:	1669227120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL LEIGH BRYANT DDS

Provider Business Mailing Address
First Line	:	1915 PEAK PRAIRIE LN
Second Line	:
City	:	MONUMENT
State	:	CO
Zip	:	80132-7813
Country	:	US
Telephone Number	:	719-661-3999
Fax Number	:

Provider Business Practice Location Address
First Line	:	5150 N ACADEMY BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-4002
Country	:	US
Telephone Number	:	719-413-8133
Fax Number	:

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

Provider Enumeration Date	:	04/18/2024
Last Update Date	:	06/10/2024

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