Provider Demographics
NPI:1912191735
Name:PHILIP, BRYAN KING (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:KING
Last Name:PHILIP
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9930 JOHNNYCAKE RIDGE RD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-6752
Mailing Address - Country:US
Mailing Address - Phone:440-352-3535
Mailing Address - Fax:
Practice Address - Street 1:9930 JOHNNYCAKE RIDGE RD
Practice Address - Street 2:SUITE 2A
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-6752
Practice Address - Country:US
Practice Address - Phone:440-352-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0163051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice