Provider Demographics
NPI:1538176888
Name:BRYANT, NILS R (DMD)
Entity type:Individual
Prefix:DR
First Name:NILS
Middle Name:R
Last Name:BRYANT
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 1:230 US HIGHWAY 206
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FLANDERS
Mailing Address - State:NJ
Mailing Address - Zip Code:07836-9189
Mailing Address - Country:US
Mailing Address - Phone:973-927-9268
Mailing Address - Fax:973-927-8984
Practice Address - Street 1:230 US HIGHWAY 206
Practice Address - Street 2:SUITE 1
Practice Address - City:FLANDERS
Practice Address - State:NJ
Practice Address - Zip Code:07836-9189
Practice Address - Country:US
Practice Address - Phone:973-927-9268
Practice Address - Fax:973-927-8984
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI20002122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist