Provider Demographics
NPI:1720110901
Name:BRYAN, EVELYN MARIE (DMD)
Entity Type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:MARIE
Last Name:BRYAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:EVELYN
Other - Middle Name:M
Other - Last Name:BRYAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD PC
Mailing Address - Street 1:765 SOUTH MAIN STREET
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102
Mailing Address - Country:US
Mailing Address - Phone:603-622-0279
Mailing Address - Fax:603-622-3542
Practice Address - Street 1:765 SO MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102
Practice Address - Country:US
Practice Address - Phone:603-622-0279
Practice Address - Fax:603-622-3542
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2508122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist