Provider Demographics
NPI:1861466385
Name:BRYANT, JOE (DDS)
Entity Type:Individual
Prefix:MR
First Name:JOE
Middle Name:
Last Name:BRYANT
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 1:20329 N 59TH AVE
Mailing Address - Street 2:SUITE A-11
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6853
Mailing Address - Country:US
Mailing Address - Phone:623-362-2000
Mailing Address - Fax:623-376-2393
Practice Address - Street 1:20329 N 59TH AVE
Practice Address - Street 2:SUITE A-11
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-6853
Practice Address - Country:US
Practice Address - Phone:623-362-2000
Practice Address - Fax:623-376-2393
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics