Provider Demographics
NPI:1689686438
Name:BRYAN, MARIA WYCHE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:WYCHE
Last Name:BRYAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-2254
Mailing Address - Country:US
Mailing Address - Phone:423-239-2777
Mailing Address - Fax:423-239-2770
Practice Address - Street 1:150 CLINIC DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37663-2254
Practice Address - Country:US
Practice Address - Phone:423-239-2777
Practice Address - Fax:423-239-2770
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0051141223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics