Provider Demographics
NPI:1720389984
Name:BRYSON, JOHN PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PAUL
Last Name:BRYSON
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 1:1203 N GLOSTER ST
Mailing Address - Street 2:SUITE M
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-1222
Mailing Address - Country:US
Mailing Address - Phone:662-823-7900
Mailing Address - Fax:662-823-7920
Practice Address - Street 1:1203 N GLOSTER ST
Practice Address - Street 2:SUITE M
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-1222
Practice Address - Country:US
Practice Address - Phone:662-823-7900
Practice Address - Fax:662-823-7920
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-04
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1452-711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice