Provider Demographics
NPI:1902960958
Name:BRYANT, LARRY WINFRED (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:WINFRED
Last Name:BRYANT
Suffix:
Gender:M
Credentials:DDS
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Other - Credentials:
Mailing Address - Street 1:12200 ANNAPOLIS RD
Mailing Address - Street 2:SUITE 236-240
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9182
Mailing Address - Country:US
Mailing Address - Phone:301-249-0553
Mailing Address - Fax:301-249-0555
Practice Address - Street 1:12200 ANNAPOLIS RD
Practice Address - Street 2:SUITE 236-240
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9182
Practice Address - Country:US
Practice Address - Phone:301-249-0553
Practice Address - Fax:301-249-0555
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2011-11-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MD77381223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU34665Medicare UPIN