Provider Demographics
NPI:1912122029
Name:CHRZAN, BRIAN GARY (DDS, PHD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:GARY
Last Name:CHRZAN
Suffix:
Gender:M
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2167 NORTHLAKE PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4103
Mailing Address - Country:US
Mailing Address - Phone:770-939-1280
Mailing Address - Fax:770-939-1284
Practice Address - Street 1:2167 NORTHLAKE PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4103
Practice Address - Country:US
Practice Address - Phone:770-939-1280
Practice Address - Fax:770-939-1284
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2010-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0485491223X0400X
NVS3-158C1223X0400X
SC46821223X0400X
GADN0140391223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics