Provider Demographics
NPI:1659589182
Name:BRYSON, KEVIN J (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:J
Last Name:BRYSON
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 1:131 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:NY
Mailing Address - Zip Code:12549-2626
Mailing Address - Country:US
Mailing Address - Phone:845-457-4544
Mailing Address - Fax:845-457-4534
Practice Address - Street 1:131 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:NY
Practice Address - Zip Code:12549-2626
Practice Address - Country:US
Practice Address - Phone:845-457-4544
Practice Address - Fax:845-457-4534
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042265-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist