Provider Demographics
NPI:1568624070
Name:BRYSON, MICHAEL JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAMES
Last Name:BRYSON
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:PO BOX 638
Mailing Address - Street 2:2907 W. 37TH STREET
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68848-0638
Mailing Address - Country:US
Mailing Address - Phone:308-234-3668
Mailing Address - Fax:308-237-5491
Practice Address - Street 1:2907 W 37TH ST STE B
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-0429
Practice Address - Country:US
Practice Address - Phone:308-234-3668
Practice Address - Fax:308-237-5491
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4638122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist