NPIMap

Organization Active NPI

Brad Bryan,DMD, PA

  • General Practice Dentistry
  • Pine Bluff, AR
National Provider Identifier
1093905465
Registry record updated Jan 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
BRAD BRYAN,DMD, PA
Practice address
2801 S Olive St
Pine Bluff, AR 71603
Phone
(770) 916-9000
Fax
(678) 302-7485
NPI assigned
Jul 31, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dale Mayfield, DMD
Title
President
Phone
(770) 916-5036

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
EndodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223E0200X
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary
Oral and Maxillofacial Surgery (Dentist)Group: 193200000X MULTI-SPECIALTY GROUP 1223S0112X

Addresses

Primary practice location

2801 S Olive St
Pine Bluff, AR 71603

Mailing address

1090 Northchase Pkwy SE Ste 150
Marietta, GA 30067-6407
Phone (770) 916-9000

Other names 1

  • Sunnybrook Dentistry Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Brad Bryan DMD PA3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2801 S Olive St
Pine Bluff, AR 71603
Phone (870) 663-4180

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1185840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1546560000000",
    "number": "1093905465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1090 NORTHCHASE PKWY SE STE 150",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300676407",
            "telephone_number": "770-916-9000",
            "fax_number": "678-247-7858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 S OLIVE ST",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "71603",
            "telephone_number": "770-916-9000",
            "fax_number": "678-302-7485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAD BRYAN,DMD, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-31",
        "last_updated": "2019-01-04",
        "status": "A",
        "authorized_official_last_name": "MAYFIELD",
        "authorized_official_first_name": "DALE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-916-5036",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sunnybrook Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pine Bluff, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.