Provider Demographics
NPI:1316082159
Name:BRYAN, GREGORY LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:LEE
Last Name:BRYAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10120 S EASTERN AVE
Mailing Address - Street 2:SUITE 345
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3951
Mailing Address - Country:US
Mailing Address - Phone:702-616-1920
Mailing Address - Fax:702-454-4716
Practice Address - Street 1:10120 S EASTERN AVE
Practice Address - Street 2:SUITE 345
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3951
Practice Address - Country:US
Practice Address - Phone:702-616-1920
Practice Address - Fax:702-454-4716
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV2214122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist