Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 0401008120 | VA |
N | 1223E0200X | Endodontist | DN 10257 | FL |
NPI | 1134190796 |
---|---|
Provider Name | Dr. Nathaniel Cedric Bryant |
First Address | Chesapeake, VA 23320-8115 |
Second Address | Chesapeake, VA 23320-8115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2006 |
Last Update Date | 22/04/2013 |