Provider Demographics
NPI:1720426216
Name:ZOLLINGER, BRYANT
Entity type:Individual
Prefix:
First Name:BRYANT
Middle Name:
Last Name:ZOLLINGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4415 S HENRYS FORK LN
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-7082
Mailing Address - Country:US
Mailing Address - Phone:509-808-8815
Mailing Address - Fax:
Practice Address - Street 1:3022 E 57TH AVE STE 10
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-7033
Practice Address - Country:US
Practice Address - Phone:509-443-8910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE606068191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice