Provider Demographics
NPI:1841710027
Name:BRYAN L RHOADS DENTISTRY, PLLC
Entity type:Organization
Organization Name:BRYAN L RHOADS DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:LEIGHTON
Authorized Official - Last Name:RHOADS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:901-258-9275
Mailing Address - Street 1:2205 SPRING RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-5925
Mailing Address - Country:US
Mailing Address - Phone:901-258-9275
Mailing Address - Fax:
Practice Address - Street 1:102 N ROBINSON ST
Practice Address - Street 2:
Practice Address - City:SENATOBIA
Practice Address - State:MS
Practice Address - Zip Code:38668-2149
Practice Address - Country:US
Practice Address - Phone:662-562-9484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS393017261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental