Provider Demographics
NPI:1336240001
Name:BRYAN, JAMES GOEBEL JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:GOEBEL
Last Name:BRYAN
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 SO MOOSE ST
Mailing Address - Street 2:
Mailing Address - City:MORRILTON
Mailing Address - State:AR
Mailing Address - Zip Code:72110-3425
Mailing Address - Country:US
Mailing Address - Phone:501-354-8623
Mailing Address - Fax:
Practice Address - Street 1:103 SO MOOSE ST
Practice Address - Street 2:
Practice Address - City:MORRILTON
Practice Address - State:AR
Practice Address - Zip Code:72110-3425
Practice Address - Country:US
Practice Address - Phone:501-354-8623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR19251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice