Provider Demographics
NPI:1003050568
Name:G. THOMAS BRYCE, JR., DDS PA
Entity Type:Organization
Organization Name:G. THOMAS BRYCE, JR., DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BRYCE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:843-662-8413
Mailing Address - Street 1:1509 W PALMETTO ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-4131
Mailing Address - Country:US
Mailing Address - Phone:843-662-8413
Mailing Address - Fax:843-662-2672
Practice Address - Street 1:1509 W PALMETTO ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4131
Practice Address - Country:US
Practice Address - Phone:843-662-8413
Practice Address - Fax:843-662-2672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1217261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental