Provider Demographics
NPI:1376327734
Name:BRYAN, LEISA (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEISA
Middle Name:
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 1:5412 E MORRISON LN
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-3017
Mailing Address - Country:US
Mailing Address - Phone:480-270-9436
Mailing Address - Fax:
Practice Address - Street 1:5412 E MORRISON LN
Practice Address - Street 2:
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-3017
Practice Address - Country:US
Practice Address - Phone:480-270-9436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDN4742122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist