Provider Demographics
NPI:1558572834
Name:HORSLEY, BRYAN P (DMD, MS)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:P
Last Name:HORSLEY
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3632 W. SOUTH JORDAN PARKWAY
Mailing Address - Street 2:#201
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095
Mailing Address - Country:US
Mailing Address - Phone:801-254-6900
Mailing Address - Fax:801-254-6969
Practice Address - Street 1:3632 W. SOUTH JORDAN PARKWAY
Practice Address - Street 2:#201
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095
Practice Address - Country:US
Practice Address - Phone:801-254-6900
Practice Address - Fax:801-254-6969
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5666702-99211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics