Provider Demographics
NPI:1427215912
Name:BIRCH, BRYANT PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRYANT
Middle Name:PAUL
Last Name:BIRCH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2280 ALEXANDRA CIR
Mailing Address - Street 2:
Mailing Address - City:GREEN RIVER
Mailing Address - State:WY
Mailing Address - Zip Code:82935-7111
Mailing Address - Country:US
Mailing Address - Phone:307-875-6833
Mailing Address - Fax:
Practice Address - Street 1:661 UINTA DR
Practice Address - Street 2:
Practice Address - City:GREEN RIVER
Practice Address - State:WY
Practice Address - Zip Code:82935
Practice Address - Country:US
Practice Address - Phone:307-875-6358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1149122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist