Provider Demographics
NPI:1932658853
Name:DAVID BRYANT DDS PLLC
Entity Type:Organization
Organization Name:DAVID BRYANT DDS PLLC
Other - Org Name:SOUTH SHORE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:461-755-8737
Mailing Address - Street 1:1525 RALEIGH ST
Mailing Address - Street 2:STE 130
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204
Mailing Address - Country:US
Mailing Address - Phone:281-755-8737
Mailing Address - Fax:866-892-0774
Practice Address - Street 1:1525 RALEIGH ST
Practice Address - Street 2:STE 130
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204
Practice Address - Country:US
Practice Address - Phone:281-755-8737
Practice Address - Fax:866-892-0774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.000106321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1528329752OtherNPI TYPE 1