Provider Demographics
NPI:1811512999
Name:HENRIE, BRYAN NIKKILAS (DDS, JD)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:NIKKILAS
Last Name:HENRIE
Suffix:
Gender:M
Credentials:DDS, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 E US HIGHWAY 24
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64050-2910
Mailing Address - Country:US
Mailing Address - Phone:913-424-8464
Mailing Address - Fax:
Practice Address - Street 1:600 E US HIGHWAY 24
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64050-2910
Practice Address - Country:US
Practice Address - Phone:913-424-8464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-14
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20230444651223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry