Provider Demographics
NPI:1619027968
Name:BRYANT, DAVID HARMON (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:HARMON
Last Name:BRYANT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:838 LOG SHOALS RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-5022
Mailing Address - Country:US
Mailing Address - Phone:864-289-0985
Mailing Address - Fax:
Practice Address - Street 1:319 THE PKWY
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-5211
Practice Address - Country:US
Practice Address - Phone:864-968-1777
Practice Address - Fax:864-968-0827
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC38101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX3810Medicaid