Provider Demographics
NPI:1477622678
Name:BRYANS, DOUGLAS ADAMS (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ADAMS
Last Name:BRYANS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:DOUGLAS
Other - Middle Name:A
Other - Last Name:BRYANS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:30 HIGGINS CROWELL ROAD
Mailing Address - Street 2:SUITE # 3
Mailing Address - City:WEST YARMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02673-3444
Mailing Address - Country:US
Mailing Address - Phone:508-775-8655
Mailing Address - Fax:508-775-4960
Practice Address - Street 1:30 HIGGINS CROWELL ROAD
Practice Address - Street 2:SUITE # 3
Practice Address - City:WEST YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02673-3444
Practice Address - Country:US
Practice Address - Phone:508-775-8655
Practice Address - Fax:508-775-4960
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA95191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice