Provider Demographics
NPI:1194131672
Name:BRYANT, KORI SUZANNE (DDS)
Entity type:Individual
Prefix:
First Name:KORI
Middle Name:SUZANNE
Last Name:BRYANT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 COLLEGE AVENUE
Mailing Address - Street 2:SUITE D164
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2940
Mailing Address - Country:US
Mailing Address - Phone:785-776-7242
Mailing Address - Fax:785-776-7243
Practice Address - Street 1:1133 COLLEGE AVENUE
Practice Address - Street 2:SUITE D164
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2940
Practice Address - Country:US
Practice Address - Phone:785-776-7242
Practice Address - Fax:785-776-7243
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-07
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS611171223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry