Provider Demographics
NPI:1942239017
Name:STOWE, BRYANT W (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:BRYANT
Middle Name:W
Last Name:STOWE
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-3780
Mailing Address - Country:US
Mailing Address - Phone:307-234-2580
Mailing Address - Fax:307-234-6992
Practice Address - Street 1:211 W 9TH ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-3780
Practice Address - Country:US
Practice Address - Phone:307-234-2580
Practice Address - Fax:307-234-6992
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD8614122300000X
WY12251223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
943096772OtherFEDERAL TAX ID
OR022868Medicaid