MEDICARE: BRYANT ZOLLINGER

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	DE60606819	WA

General Provider Information

NPI Number	:	1720426216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYANT ZOLLINGER

Provider Business Mailing Address
First Line	:	4415 S HENRYS FORK LN
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99206-7082
Country	:	US
Telephone Number	:	509-808-8815
Fax Number	:

Provider Business Practice Location Address
First Line	:	3022 E 57TH AVE STE 10
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99223-7033
Country	:	US
Telephone Number	:	509-443-8910
Fax Number	:

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

Provider Enumeration Date	:	06/06/2013
Last Update Date	:	07/20/2021

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1588115471 — THERAPEUTIC ASSOCIATES INC
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1629541552 — ZOLLINGER, PLLC
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Directions to “ BRYANT ZOLLINGER ” Practice Location

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