Provider Demographics
NPI:1699950451
Name:ENGHIRST, BRYAN J (DDS)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:J
Last Name:ENGHIRST
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:BRYAN
Other - Middle Name:J
Other - Last Name:HIRST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:11431 BUSINESS BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7738
Mailing Address - Country:US
Mailing Address - Phone:907-696-2875
Mailing Address - Fax:
Practice Address - Street 1:11431 BUSINESS BLVD STE 5
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7738
Practice Address - Country:US
Practice Address - Phone:907-696-2875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK11461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice