Provider Demographics
NPI:1700198231
Name:ANDERSON, BRYANT MARSHALL (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRYANT
Middle Name:MARSHALL
Last Name:ANDERSON
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 1:1435 HOWELL BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-1157
Mailing Address - Country:US
Mailing Address - Phone:407-644-5454
Mailing Address - Fax:
Practice Address - Street 1:1435 HOWELL BRANCH RD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-1157
Practice Address - Country:US
Practice Address - Phone:407-644-5454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 19033122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist