Provider Demographics
NPI:1184944050
Name:FLETCHER, BRYAN DONALD (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:DONALD
Last Name:FLETCHER
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3564 VAN BUREN BLVD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-4214
Mailing Address - Country:US
Mailing Address - Phone:951-688-5412
Mailing Address - Fax:
Practice Address - Street 1:650 N MILLER ST
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2044
Practice Address - Country:US
Practice Address - Phone:509-662-3621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA590531223P0221X
WA602608941223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry