Provider Demographics
NPI:1710093281
Name:SIDNEY R BRYSON DMD PA
Entity Type:Organization
Organization Name:SIDNEY R BRYSON DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRYSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-638-5851
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:107 N EARLE STREET
Mailing Address - City:WALHALLA
Mailing Address - State:SC
Mailing Address - Zip Code:29691
Mailing Address - Country:US
Mailing Address - Phone:864-638-5851
Mailing Address - Fax:864-638-5850
Practice Address - Street 1:107 N EARLE ST
Practice Address - Street 2:
Practice Address - City:WALHALLA
Practice Address - State:SC
Practice Address - Zip Code:29691
Practice Address - Country:US
Practice Address - Phone:864-638-5851
Practice Address - Fax:864-638-5850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty