Provider Demographics
NPI:1841720620
Name:RHOADS, BRYAN LEIGHTON
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:LEIGHTON
Last Name:RHOADS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3930-171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice