Provider Demographics
NPI:1831139427
Name:BRYAN, PAUL W (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:W
Last Name:BRYAN
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 1:2903 E MAIN
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3169
Mailing Address - Country:US
Mailing Address - Phone:253-845-9507
Mailing Address - Fax:253-845-5751
Practice Address - Street 1:2903 E MAIN
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3169
Practice Address - Country:US
Practice Address - Phone:253-845-9507
Practice Address - Fax:253-845-5751
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA57831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5059001OtherDSHS PROVIDER NUMBER
WA717917OtherUNITED CONCORDIA & TRICAR
WA7192OtherWASHINGTON DENTAL SERVICE
WA93062OtherL&I PROVIDER NUMBER
WAAB1913070OtherDEA NUMBER