Provider Demographics
NPI:1356432124
Name:AUNGST, BRYAN DAVID (DMD)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:DAVID
Last Name:AUNGST
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4579 E PLEASANT VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:PA
Mailing Address - Zip Code:16686-7032
Mailing Address - Country:US
Mailing Address - Phone:814-684-9455
Mailing Address - Fax:814-684-9473
Practice Address - Street 1:4579 E PLEASANT VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:PA
Practice Address - Zip Code:16686-7032
Practice Address - Country:US
Practice Address - Phone:814-684-9455
Practice Address - Fax:814-684-9473
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029429L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA245401OtherDENTA BENEFIT PROVIDERS
PA01902813Medicaid
PA789832OtherUNITED CONCORDIA