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Contact Information

BRAD BRYAN,DMD, PA
2801 S OLIVE ST
PINE BLUFF, AR71603
 Phone: 770-916-9000
 Fax: 678-302-7485
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

General Practice

1223G0001X
 

Endodontics

1223E0200X
 

Oral and Maxillofacial Surgery

1223S0112X 19 Oral Surgery (Dentist only)
Indicates primary specialty

NPI Profile & details for BRAD BRYAN,DMD, PA

NPI Number 1093905465
LBN Legal business name BRAD BRYAN,DMD, PA
Authorized official DALE MAYFIELD - (PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 07/31/2007
Last updated 01/04/2019 - About 7 years ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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