Provider Demographics
NPI:1659938132
Name:BRYAN ST DENTAL PLLC
Entity Type:Organization
Organization Name:BRYAN ST DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:WHILBY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:956-583-5050
Mailing Address - Street 1:210 S BRYAN RD STE 4
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-6208
Mailing Address - Country:US
Mailing Address - Phone:956-585-7677
Mailing Address - Fax:956-585-7627
Practice Address - Street 1:210 S BRYAN RD STE 4
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6208
Practice Address - Country:US
Practice Address - Phone:956-585-7677
Practice Address - Fax:956-585-7627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty