Provider Demographics
NPI:1538280839
Name:OETH, BRYAN DAYLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:DAYLE
Last Name:OETH
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 1:728 CATTAIL CT NE
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-3166
Mailing Address - Country:US
Mailing Address - Phone:727-527-3842
Mailing Address - Fax:
Practice Address - Street 1:239 2ND AVE S STE 100
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4312
Practice Address - Country:US
Practice Address - Phone:727-898-8585
Practice Address - Fax:727-898-8588
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN114951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice