Provider Demographics
NPI:1710122403
Name:REBECCA C. BRYAN D.D.S.,P. A.
Entity Type:Organization
Organization Name:REBECCA C. BRYAN D.D.S.,P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,PA
Authorized Official - Phone:479-271-9900
Mailing Address - Street 1:1001 SE 28TH ST STE 7
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3206
Mailing Address - Country:US
Mailing Address - Phone:479-271-9900
Mailing Address - Fax:479-271-8290
Practice Address - Street 1:1001 SE 28TH ST STE 7
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3206
Practice Address - Country:US
Practice Address - Phone:479-271-9900
Practice Address - Fax:479-271-8290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR32861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty