Provider Demographics
NPI:1144011974
Name:ANDERSON, BRYCE (DMD)
Entity type:Individual
Prefix:DR
First Name:BRYCE
Middle Name:
Last Name:ANDERSON
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 1:26 WILBUR LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-8590
Mailing Address - Country:US
Mailing Address - Phone:937-558-6961
Mailing Address - Fax:
Practice Address - Street 1:721 MIAMI CHAPEL RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-4650
Practice Address - Country:US
Practice Address - Phone:937-281-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.027974122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist