Provider Demographics
NPI:1659386142
Name:TALBOT, BRYON J (DDS)
Entity Type:Individual
Prefix:
First Name:BRYON
Middle Name:J
Last Name:TALBOT
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 1:5640 S WASATCH DRIVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403
Mailing Address - Country:US
Mailing Address - Phone:801-479-4830
Mailing Address - Fax:801-479-3341
Practice Address - Street 1:5640 S WASATCH DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403
Practice Address - Country:US
Practice Address - Phone:801-479-4830
Practice Address - Fax:801-479-3341
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2645359923122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist