Provider Demographics
NPI:1881203529
Name:DILLER, BRYNNA (DDS)
Entity Type:Individual
Prefix:
First Name:BRYNNA
Middle Name:
Last Name:DILLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7649 HILLSIDE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-8382
Mailing Address - Country:US
Mailing Address - Phone:806-358-7633
Mailing Address - Fax:
Practice Address - Street 1:7649 HILLSIDE RD STE 100
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-8382
Practice Address - Country:US
Practice Address - Phone:806-358-7633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice