Provider Demographics
NPI:1063039501
Name:BRYANT, SHAE DANIEL (DDS)
Entity type:Individual
Prefix:MR
First Name:SHAE
Middle Name:DANIEL
Last Name:BRYANT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIT 5210 BOX 230
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09461-5210
Mailing Address - Country:US
Mailing Address - Phone:702-423-7241
Mailing Address - Fax:
Practice Address - Street 1:BUILDING 944, RAF LAKENHEATH
Practice Address - Street 2:48TH MEDICAL GROUP / SGD
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09461-5300
Practice Address - Country:US
Practice Address - Phone:702-423-7241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11826424-9924204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery