Provider Demographics
NPI:1487768545
Name:DRYDEN, BRYAN RADER (DDS)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:RADER
Last Name:DRYDEN
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 1:2344 N MERRITT CREEK LOOP
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-4950
Mailing Address - Country:US
Mailing Address - Phone:208-676-8500
Mailing Address - Fax:208-246-2400
Practice Address - Street 1:2344 N MERRITT CREEK LOOP
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4950
Practice Address - Country:US
Practice Address - Phone:208-676-8500
Practice Address - Fax:208-246-2400
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID3332122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID6B836OtherBLUE CROSS OF IDAHO