Provider Demographics
NPI:1427407212
Name:FRY, BRYSON DANE (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRYSON
Middle Name:DANE
Last Name:FRY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:891 HUDSON BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:NANCY
Mailing Address - State:KY
Mailing Address - Zip Code:42544-8533
Mailing Address - Country:US
Mailing Address - Phone:606-219-6020
Mailing Address - Fax:
Practice Address - Street 1:296 MEDPARK DR
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2894
Practice Address - Country:US
Practice Address - Phone:606-677-0238
Practice Address - Fax:606-679-2149
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY97931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice