Provider Demographics
NPI:1316926173
Name:BRYANT, RICHARD H (DMD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:H
Last Name:BRYANT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1423 ALICE DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-2660
Mailing Address - Country:US
Mailing Address - Phone:843-667-6660
Mailing Address - Fax:843-661-0836
Practice Address - Street 1:1423 ALICE DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-2660
Practice Address - Country:US
Practice Address - Phone:843-667-6660
Practice Address - Fax:843-661-0836
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20481223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC433967Medicaid