Provider Demographics
NPI:1669227120
Name:BRYANT, RACHEL LEIGH (DDS)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:LEIGH
Last Name:BRYANT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 PEAK PRAIRIE LN
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-7813
Mailing Address - Country:US
Mailing Address - Phone:719-661-3999
Mailing Address - Fax:
Practice Address - Street 1:5150 N ACADEMY BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-4002
Practice Address - Country:US
Practice Address - Phone:719-413-8133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-18
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00205988122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist