Provider Demographics
NPI:1083728968
Name:BRYSON, JOHN WEST (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WEST
Last Name:BRYSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4 TRAPPER CT
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31820-3807
Mailing Address - Country:US
Mailing Address - Phone:706-544-4530
Mailing Address - Fax:706-544-1933
Practice Address - Street 1:7101 HOFF ST,BLDG 9240
Practice Address - Street 2:USA DENTAL ACTIVITY
Practice Address - City:FORT BENNING
Practice Address - State:GA
Practice Address - Zip Code:31905
Practice Address - Country:US
Practice Address - Phone:706-544-4530
Practice Address - Fax:706-544-1933
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN009620122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223P0221XDental ProvidersDentistPediatric Dentistry