Provider Demographics
NPI:1902098551
Name:EUZENT, BRYAN S (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:S
Last Name:EUZENT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8220 SW WARM SPRINGS ST STE 200
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-9347
Mailing Address - Country:US
Mailing Address - Phone:503-629-0337
Mailing Address - Fax:
Practice Address - Street 1:8220 SW WARM SPRINGS ST STE 200
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-9347
Practice Address - Country:US
Practice Address - Phone:503-629-0337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD8870122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist