Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 6969 | TN |
NPI | 1063051654 |
---|---|
Provider Name | Brittany Bryson |
First Address | Ripley, TN 38063-6407 |
Second Address | Bartlett, TN 38134-2882 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2019 |
Last Update Date | 30/12/2019 |