Provider Demographics
NPI:1699721290
Name:BRYANT, MICHELLE LEIVETTE (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:LEIVETTE
Last Name:BRYANT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3450 WAYNE AVE
Mailing Address - Street 2:APT. 26G
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2510
Mailing Address - Country:US
Mailing Address - Phone:646-369-7363
Mailing Address - Fax:
Practice Address - Street 1:ATLANTIC ORAL SURGERY AND DENTAL IMPLANT CENTER
Practice Address - Street 2:21GILBERT ST. NORTH
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07701
Practice Address - Country:US
Practice Address - Phone:732-747-0993
Practice Address - Fax:732-412-9317
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI023341001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery