Provider Demographics
NPI:1508906934
Name:BRYAN, STEVEN CLARK (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:CLARK
Last Name:BRYAN
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 1:2632 MITCHAM DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5400
Mailing Address - Country:US
Mailing Address - Phone:850-878-7101
Mailing Address - Fax:850-942-2652
Practice Address - Street 1:2632 MITCHAM DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5400
Practice Address - Country:US
Practice Address - Phone:850-878-7101
Practice Address - Fax:850-942-2652
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 86661223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery