Provider Demographics
NPI:1184276321
Name:BRYAN DODD DDS, INC.
Entity type:Organization
Organization Name:BRYAN DODD DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:SHERMAN
Authorized Official - Last Name:DODD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:937-429-9999
Mailing Address - Street 1:3223 BEAVER VU DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45434-6371
Mailing Address - Country:US
Mailing Address - Phone:937-429-9999
Mailing Address - Fax:937-427-3087
Practice Address - Street 1:3223 BEAVER VU DR
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45434-6371
Practice Address - Country:US
Practice Address - Phone:937-429-9999
Practice Address - Fax:937-427-3087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty