Provider Demographics
NPI:1962573634
Name:KREY, BRYAN REED (DMD)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:REED
Last Name:KREY
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 1:2522 DANA ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2803
Mailing Address - Country:US
Mailing Address - Phone:510-848-1055
Mailing Address - Fax:510-848-9100
Practice Address - Street 1:2522 DANA ST
Practice Address - Street 2:SUITE 202
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2803
Practice Address - Country:US
Practice Address - Phone:510-848-1055
Practice Address - Fax:510-848-9100
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA449121223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADS0449120Medicare ID - Type Unspecified