Provider Demographics
NPI:1225141880
Name:BRYAN, REBECCA C (DDS PA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:C
Last Name:BRYAN
Suffix:
Gender:F
Credentials:DDS PA
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:COBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS PA
Mailing Address - Street 1:502 SE FULLERTON
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712
Mailing Address - Country:US
Mailing Address - Phone:479-273-0485
Mailing Address - Fax:
Practice Address - Street 1:1001 SE 28TH ST
Practice Address - Street 2:STE 7
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712
Practice Address - Country:US
Practice Address - Phone:479-271-9900
Practice Address - Fax:479-271-8290
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3286122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist