Provider Demographics
NPI:1902073752
Name:SUYDAM, BRYAN (DMD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:SUYDAM
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 1:1099 OHIO RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-2056
Mailing Address - Country:US
Mailing Address - Phone:412-741-1234
Mailing Address - Fax:412-741-1585
Practice Address - Street 1:1099 OHIO RIVER BLVD
Practice Address - Street 2:
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-2056
Practice Address - Country:US
Practice Address - Phone:412-741-1234
Practice Address - Fax:412-741-1585
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS039902122300000X, 1223G0001X
HIDT-23681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist