Provider Demographics
NPI:1093758732
Name:BRYAN, ROBERT TAYLOR (DMD, PLLC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:TAYLOR
Last Name:BRYAN
Suffix:
Gender:M
Credentials:DMD, PLLC
Other - Prefix:MRS
Other - First Name:CLAIRE
Other - Middle Name:ANN
Other - Last Name:BRYAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OFFICE MANAGER
Mailing Address - Street 1:P.O. BOX 843
Mailing Address - Street 2:315 MCLEOD ST
Mailing Address - City:BIG TIMBER
Mailing Address - State:MT
Mailing Address - Zip Code:59011-0843
Mailing Address - Country:US
Mailing Address - Phone:406-932-5919
Mailing Address - Fax:
Practice Address - Street 1:315 MCLEOD ST
Practice Address - Street 2:
Practice Address - City:BIG TIMBER
Practice Address - State:MT
Practice Address - Zip Code:59011-0843
Practice Address - Country:US
Practice Address - Phone:406-932-5919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT15071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice