Provider Demographics
NPI:1255851648
Name:BRYAN, JENNA TENNISWOOD (DMD)
Entity Type:Individual
Prefix:DR
First Name:JENNA
Middle Name:TENNISWOOD
Last Name:BRYAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 NE 3RD ST
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972-2947
Mailing Address - Country:US
Mailing Address - Phone:863-763-3909
Mailing Address - Fax:
Practice Address - Street 1:208 NE 3RD ST
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-2947
Practice Address - Country:US
Practice Address - Phone:863-763-3909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN22723122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist