Provider Demographics
NPI:1902972706
Name:BRYANT, LANORA ELAINE (DDS)
Entity Type:Individual
Prefix:
First Name:LANORA
Middle Name:ELAINE
Last Name:BRYANT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:LANORA
Other - Middle Name:
Other - Last Name:MAURICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:37 BON AIR CIRCLE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305
Mailing Address - Country:US
Mailing Address - Phone:731-660-4613
Mailing Address - Fax:
Practice Address - Street 1:804 N PARKWAY
Practice Address - Street 2:JACKSON MADISON COUNTY REGIONAL HEALTH DEPT
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3058
Practice Address - Country:US
Practice Address - Phone:731-423-3020
Practice Address - Fax:731-927-8600
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS3606122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist