Provider Demographics
NPI:1962616458
Name:DARDEN, BRYCE MASON (DDS)
Entity type:Individual
Prefix:DR
First Name:BRYCE
Middle Name:MASON
Last Name:DARDEN
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 1:175 N PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-3316
Mailing Address - Country:US
Mailing Address - Phone:626-963-6006
Mailing Address - Fax:626-963-1235
Practice Address - Street 1:175 N PENNSYLVANIA AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-3316
Practice Address - Country:US
Practice Address - Phone:626-963-6006
Practice Address - Fax:626-963-1235
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48592122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist