Provider Demographics
NPI:1649489840
Name:PIERCE, BRYAN EDWARD
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:EDWARD
Last Name:PIERCE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:NONE
Other - Middle Name:
Other - Last Name:NONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:11400 DONNER PASS RD
Mailing Address - Street 2:SUITE 50
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-4921
Mailing Address - Country:US
Mailing Address - Phone:530-587-6096
Mailing Address - Fax:530-587-6097
Practice Address - Street 1:11400 DONNER PASS RD
Practice Address - Street 2:SUITE 50
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4921
Practice Address - Country:US
Practice Address - Phone:530-587-6096
Practice Address - Fax:530-587-6097
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA429431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice