Provider Demographics
NPI:1710152822
Name:SPRINGER, BRYAN K (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:K
Last Name:SPRINGER
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 1:1283 N LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-7647
Mailing Address - Country:US
Mailing Address - Phone:803-957-3005
Mailing Address - Fax:803-957-5011
Practice Address - Street 1:1283 N LAKE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-7647
Practice Address - Country:US
Practice Address - Phone:803-957-3005
Practice Address - Fax:803-957-5011
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice