Provider Demographics
NPI:1699845438
Name:CLOE, BRYAN CHRISTOPHER (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:CHRISTOPHER
Last Name:CLOE
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 1:1216 AMERICAN WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-3938
Mailing Address - Country:US
Mailing Address - Phone:847-680-1030
Mailing Address - Fax:847-680-1129
Practice Address - Street 1:1216 AMERICAN WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3938
Practice Address - Country:US
Practice Address - Phone:847-680-1030
Practice Address - Fax:847-680-1129
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice