Provider Demographics
NPI:1285858738
Name:TO, BRYANT LAM (DDS)
Entity Type:Individual
Prefix:MR
First Name:BRYANT
Middle Name:LAM
Last Name:TO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:MR
Other - First Name:LAM
Other - Middle Name:NGOC
Other - Last Name:TO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:14100 ROBERT PARIS CT
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151
Mailing Address - Country:US
Mailing Address - Phone:571-287-7301
Mailing Address - Fax:571-287-7302
Practice Address - Street 1:14100 ROBERT PARIS CT
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151
Practice Address - Country:US
Practice Address - Phone:571-287-7301
Practice Address - Fax:571-287-7302
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410949122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist