Provider Demographics
NPI:1184844656
Name:BRYANT, MELBA WILLIAMS
Entity type:Individual
Prefix:DR
First Name:MELBA
Middle Name:WILLIAMS
Last Name:BRYANT
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:MELBA
Other - Middle Name:SERTENIA
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4260 CROSSINGS BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PRINCE GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23875-1400
Mailing Address - Country:US
Mailing Address - Phone:804-452-5800
Mailing Address - Fax:804-452-5801
Practice Address - Street 1:4260 CROSSINGS BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:PRINCE GEORGE
Practice Address - State:VA
Practice Address - Zip Code:23875-1400
Practice Address - Country:US
Practice Address - Phone:804-452-5800
Practice Address - Fax:804-452-5801
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04011026871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice