Provider Demographics
NPI:1609815380
Name:DYESS, BRIAN NELSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:NELSON
Last Name:DYESS
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 1:7777 HENNESSY BLVD
Mailing Address - Street 2:STE 610
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4300
Mailing Address - Country:US
Mailing Address - Phone:225-769-2278
Mailing Address - Fax:225-769-2299
Practice Address - Street 1:7777 HENNESSY BLVD
Practice Address - Street 2:STE 610
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4300
Practice Address - Country:US
Practice Address - Phone:225-769-2278
Practice Address - Fax:225-769-2299
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA38211223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1838217Medicaid
LA58257Medicare ID - Type UnspecifiedPROVIDER
LA1838217Medicaid