Provider Demographics
NPI:1326579384
Name:BRYANT M ANDERSON DMD
Entity Type:Organization
Organization Name:BRYANT M ANDERSON DMD
Other - Org Name:ANDERSON FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYANT
Authorized Official - Middle Name:MARSHALL
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-644-5454
Mailing Address - Street 1:1431 HOWELL BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-1101
Mailing Address - Country:US
Mailing Address - Phone:407-644-5454
Mailing Address - Fax:407-289-5257
Practice Address - Street 1:1431 HOWELL BRANCH RD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-1101
Practice Address - Country:US
Practice Address - Phone:407-644-5454
Practice Address - Fax:407-289-5257
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANDERSON FAMILY DENTAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19033122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty