Provider Demographics
NPI:1477827293
Name:BRYANT, COLEMAN (DDS)
Entity Type:Individual
Prefix:
First Name:COLEMAN
Middle Name:
Last Name:BRYANT
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 1:3372 W BARCELONA DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-1465
Mailing Address - Country:US
Mailing Address - Phone:614-226-3438
Mailing Address - Fax:
Practice Address - Street 1:14425 W MCDOWELL RD
Practice Address - Street 2:SUITE F-102
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2516
Practice Address - Country:US
Practice Address - Phone:623-536-0079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-24
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN4307122300000X
OH30.023636122300000X
AZD009203122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist