Provider Demographics
NPI:1558516237
Name:GOVER, BRYAN (DDS)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:GOVER
Suffix:
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 1:18053 COTTAGE GARDEN DR
Mailing Address - Street 2:APARTMENT #203
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-5808
Mailing Address - Country:US
Mailing Address - Phone:301-972-9550
Mailing Address - Fax:
Practice Address - Street 1:8 RUSSELL AVE
Practice Address - Street 2:SUITE #105
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2966
Practice Address - Country:US
Practice Address - Phone:301-216-0592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-23
Last Update Date:2008-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD115001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice