Provider Demographics
NPI:1861668592
Name:BUMPAS, BRYAN CHRISTOPHER
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:CHRISTOPHER
Last Name:BUMPAS
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:BRYAN
Other - Middle Name:CHRISTOPHER
Other - Last Name:BUMPAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1200 NW 192ND ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-4031
Mailing Address - Country:US
Mailing Address - Phone:405-282-6444
Mailing Address - Fax:405-282-6457
Practice Address - Street 1:1200 NW 192ND ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-4031
Practice Address - Country:US
Practice Address - Phone:405-282-6444
Practice Address - Fax:405-282-6457
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK53671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty