Provider Demographics
NPI:1720871296
Name:BRUCETON MILLS FAMILY DENTISTRY
Entity type:Organization
Organization Name:BRUCETON MILLS FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SAVANNAH
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BRYNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-276-3225
Mailing Address - Street 1:210 SANTORINI AVE
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-5986
Mailing Address - Country:US
Mailing Address - Phone:304-276-3225
Mailing Address - Fax:
Practice Address - Street 1:10 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:BRUCETON MILLS
Practice Address - State:WV
Practice Address - Zip Code:26525-9415
Practice Address - Country:US
Practice Address - Phone:304-903-9062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental