Provider Demographics
NPI:1578201778
Name:BRYSON DENTAL P.L.L.C
Entity Type:Organization
Organization Name:BRYSON DENTAL P.L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DOREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-231-9630
Mailing Address - Street 1:7785 M-36 BOX 569
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48139-0569
Mailing Address - Country:US
Mailing Address - Phone:586-864-4675
Mailing Address - Fax:
Practice Address - Street 1:7785 E. M-36
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:MI
Practice Address - Zip Code:48139
Practice Address - Country:US
Practice Address - Phone:810-231-9630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental