Provider Demographics
NPI:1124119656
Name:BRYANT, DONNIE (D D S)
Entity type:Individual
Prefix:
First Name:DONNIE
Middle Name:
Last Name:BRYANT
Suffix:
Gender:M
Credentials:D D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:AR
Mailing Address - Zip Code:71671-2809
Mailing Address - Country:US
Mailing Address - Phone:870-226-6556
Mailing Address - Fax:870-226-6150
Practice Address - Street 1:105 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:AR
Practice Address - Zip Code:71671-2809
Practice Address - Country:US
Practice Address - Phone:870-226-6556
Practice Address - Fax:870-226-6150
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2181122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist