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NPI Code Detail

MEDICARE: LANORA ELAINE BRYANT DDS

MEDICARE: LANORA ELAINE 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
1122300000XDentistDS3606TN

General Provider Information

NPI Number : 1902972706
Entity Type Code : Individual
Provider Name (Legal Business Name) : LANORA ELAINE BRYANT DDS
Provider Business Mailing Address
First Line : 37 BON AIR CIRCLE
Second Line :
City : JACKSON
State : TN
Zip : 38305
Country : US
Telephone Number : 731-660-4613
Fax Number :
Provider Business Practice Location Address
First Line : 804 N PARKWAY
Second Line : JACKSON MADISON COUNTY REGIONAL HEALTH DEPT
City : JACKSON
State : TN
Zip : 38305-3058
Country : US
Telephone Number : 731-423-3020
Fax Number : 731-927-8600
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/27/2006
Last Update Date : 02/22/2012

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Directions to “ LANORA ELAINE BRYANT DDS” Practice Location

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