Provider Demographics
NPI:1376291898
Name:GREGORY S. BRYA, DDS, PLLC
Entity Type:Organization
Organization Name:GREGORY S. BRYA, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BRYA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-281-2031
Mailing Address - Street 1:4780 OKEMOS RD STE 1
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-1669
Mailing Address - Country:US
Mailing Address - Phone:517-381-8181
Mailing Address - Fax:517-381-8170
Practice Address - Street 1:4780 OKEMOS RD STE 1
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-1669
Practice Address - Country:US
Practice Address - Phone:517-381-8181
Practice Address - Fax:517-381-8170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental