Provider Demographics
NPI:1730139635
Name:KALISH, BRYAN PATRICK (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:PATRICK
Last Name:KALISH
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6901 HELEN OF TROY STE A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79911-3049
Mailing Address - Country:US
Mailing Address - Phone:637-192-9130
Mailing Address - Fax:915-581-9797
Practice Address - Street 1:6901 HELEN OF TROY STE A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79911-3049
Practice Address - Country:US
Practice Address - Phone:637-192-9130
Practice Address - Fax:915-581-9797
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX235511223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics