Provider Demographics
NPI:1366612947
Name:BRYN GARDD DENTAL CARE, LTD.
Entity type:Organization
Organization Name:BRYN GARDD DENTAL CARE, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:B
Authorized Official - Last Name:LYKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:320-587-2769
Mailing Address - Street 1:945 ECHO DR SE
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:MN
Mailing Address - Zip Code:55350-5100
Mailing Address - Country:US
Mailing Address - Phone:320-587-2769
Mailing Address - Fax:320-587-0321
Practice Address - Street 1:945 ECHO DR SE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-5100
Practice Address - Country:US
Practice Address - Phone:320-587-2769
Practice Address - Fax:320-587-0321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty