Provider Demographics
NPI:1043712854
Name:BRYAN T. PERSINGER DDS PA II
Entity Type:Organization
Organization Name:BRYAN T. PERSINGER DDS PA II
Other - Org Name:WATERSIDE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:PERSINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-951-8300
Mailing Address - Street 1:19628 WEAVERS CIR
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-7534
Mailing Address - Country:US
Mailing Address - Phone:704-236-0063
Mailing Address - Fax:
Practice Address - Street 1:175 CROSS CENTER ROAD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037
Practice Address - Country:US
Practice Address - Phone:704-951-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty