Basic Information
| Provider Information | |||||||||
| NPI: | 1083728968 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRYSON | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | WEST | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 TRAPPER CT | ||||||||
| Address2: | |||||||||
| City: | MIDLAND | ||||||||
| State: | GA | ||||||||
| PostalCode: | 318203807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7065444530 | ||||||||
| FaxNumber: | 7065441933 | ||||||||
| Practice Location | |||||||||
| Address1: | 7101 HOFF ST,BLDG 9240 | ||||||||
| Address2: | USA DENTAL ACTIVITY | ||||||||
| City: | FORT BENNING | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7065444530 | ||||||||
| FaxNumber: | 7065441933 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DN009620 | GA | X | Dental Providers | Dentist | 1223P0221X | DN009620 | GA | X | Dental Providers | Dentist | Pediatric Dentistry |
No ID Information.