Provider Demographics
NPI:1316236631
Name:MATTHEW T. BRYNER, P.C.
Entity type:Organization
Organization Name:MATTHEW T. BRYNER, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:TED
Authorized Official - Last Name:BRYNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-565-5457
Mailing Address - Street 1:217 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-3135
Mailing Address - Country:US
Mailing Address - Phone:970-565-5457
Mailing Address - Fax:970-565-2496
Practice Address - Street 1:217 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-3135
Practice Address - Country:US
Practice Address - Phone:970-565-5457
Practice Address - Fax:970-565-2496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO97511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty