Provider Demographics
NPI:1144424169
Name:EVELYN M BRYAN DMD PC
Entity Type:Organization
Organization Name:EVELYN M BRYAN DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-622-0279
Mailing Address - Street 1:765 S MAIN ST
Mailing Address - Street 2:STE 202
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102
Mailing Address - Country:US
Mailing Address - Phone:603-622-0279
Mailing Address - Fax:603-622-3542
Practice Address - Street 1:765 S MAIN ST
Practice Address - Street 2:STE 202
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102
Practice Address - Country:US
Practice Address - Phone:603-622-0279
Practice Address - Fax:603-622-3542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty