Provider Demographics
NPI:1689899650
Name:BERTEAUX, BRYAN S (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:S
Last Name:BERTEAUX
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 1:23922 CINCO VILLAGE CENTER BLVD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-6619
Mailing Address - Country:US
Mailing Address - Phone:281-371-3636
Mailing Address - Fax:281-371-3640
Practice Address - Street 1:23922 CINCO VILLAGE CENTER BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-6619
Practice Address - Country:US
Practice Address - Phone:281-371-3636
Practice Address - Fax:281-371-3640
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX231091223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics