Provider Demographics
NPI:1891988531
Name:BRYANT, MICHAEL DARRH (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DARRH
Last Name:BRYANT
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 1:1234 TIMBERLANE RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-1710
Mailing Address - Country:US
Mailing Address - Phone:850-656-5600
Mailing Address - Fax:850-665-5970
Practice Address - Street 1:1234 TIMBERLANE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-1710
Practice Address - Country:US
Practice Address - Phone:850-656-5600
Practice Address - Fax:850-665-5970
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16673122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist