Provider Demographics
NPI:1194536136
Name:BRYAN T PERSINGER DDS PLLC III
Entity type:Organization
Organization Name:BRYAN T PERSINGER DDS PLLC III
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PERSINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-778-6757
Mailing Address - Street 1:19628 WEAVERS CIR
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-7534
Mailing Address - Country:US
Mailing Address - Phone:704-778-6757
Mailing Address - Fax:
Practice Address - Street 1:10011 BIDDICK LN STE 140
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-8210
Practice Address - Country:US
Practice Address - Phone:704-778-6757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRYAN T PERSINGER DDS PLLC III
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty