Provider Demographics
NPI:1821059882
Name:BRYA, GREGORY SCOTT (DDS)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:SCOTT
Last Name:BRYA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4780 OKEMOS ROAD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864
Mailing Address - Country:US
Mailing Address - Phone:517-381-8181
Mailing Address - Fax:517-381-8170
Practice Address - Street 1:4780 OKEMOS ROAD
Practice Address - Street 2:SUITE #1
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864
Practice Address - Country:US
Practice Address - Phone:517-381-8181
Practice Address - Fax:517-381-8170
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI2901016587122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist