Provider Demographics
NPI:1487073888
Name:BRYAN, JOSHUA AUSTIN (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:AUSTIN
Last Name:BRYAN
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 1:34359 CARPENTER'S WAY
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-4910
Mailing Address - Country:US
Mailing Address - Phone:302-645-8993
Mailing Address - Fax:
Practice Address - Street 1:34359 CARPENTERS WAY
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-4910
Practice Address - Country:US
Practice Address - Phone:302-645-8993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-14
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-0001359122300000X
NJ22DI02570900122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist