Provider Demographics
NPI:1174526727
Name:BRYANT, KEVIN P (DMD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:P
Last Name:BRYANT
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 1:1001 CARTER STREET
Mailing Address - Street 2:SUITE H
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37402
Mailing Address - Country:US
Mailing Address - Phone:423-267-1853
Mailing Address - Fax:423-267-9518
Practice Address - Street 1:1001 CARTER ST
Practice Address - Street 2:STE H
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402-5014
Practice Address - Country:US
Practice Address - Phone:423-267-1853
Practice Address - Fax:423-267-9518
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-27
Last Update Date:2007-07-08
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-20
Provider Licenses
StateLicense IDTaxonomies
TN71101223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics