| Emory W. Bryan, Jr.,d.d.s., P.c. | |
|
6427 Georgetown North Blvd Fort Wayne IN 46815-7007 | |
| (260) 485-9142 | |
| (260) 485-9783 |
| Full Name | Emory W. Bryan, Jr.,d.d.s., P.c. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 6427 Georgetown North Blvd, Fort Wayne, Indiana |
| Authorized Official Name and Position | Emory Wallace Bryan (PRESIDENT) |
| Authorized Official Contact | 2604859142 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Emory W. Bryan, Jr.,d.d.s., P.c. 6427 Georgetown North Blvd Fort Wayne IN 46815-7007 Ph: (260) 485-9142 | Emory W. Bryan, Jr.,d.d.s., P.c. 6427 Georgetown North Blvd Fort Wayne IN 46815-7007 Ph: (260) 485-9142 |
| NPI Number | 1417008947 |
|---|---|
| Provider Enumeration Date | 01/12/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417008947 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 54000568A (Indiana) | Primary |
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