Provider Demographics
NPI:1114230281
Name:DOTY, BRYCE R (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRYCE
Middle Name:R
Last Name:DOTY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S ANAHEIM HILLS RD STE 146
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-4761
Mailing Address - Country:US
Mailing Address - Phone:503-918-2007
Mailing Address - Fax:
Practice Address - Street 1:500 S ANAHEIM HILLS RD STE 146
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-4761
Practice Address - Country:US
Practice Address - Phone:503-318-2007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9458122300000X
CA61359122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist