Provider Demographics
NPI:1578659330
Name:BRYSON, KIMBERLY M (DDS)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:M
Last Name:BRYSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 SW 336TH ST
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-2883
Mailing Address - Country:US
Mailing Address - Phone:253-927-7777
Mailing Address - Fax:253-927-6319
Practice Address - Street 1:2122 SW 336TH ST
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-2883
Practice Address - Country:US
Practice Address - Phone:253-927-7777
Practice Address - Fax:253-927-6319
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000103371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice