Bryan Packard

Primary specialty

DentistTaxonomy code 122300000X

License

019.030304 Issued in IL

Practice address

343 Warrior Rd
BLDG 2115
Fort Stewart, GA 31314

Phone

(912) 767-4440

NPI assigned

Sep 16, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1442361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1194194431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 CONCORDIA DR",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314196228",
            "telephone_number": "270-792-5530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "343 WARRIOR RD",
            "address_2": "BLDG 2115",
            "city": "FORT STEWART",
            "state": "GA",
            "postal_code": "31314",
            "telephone_number": "912-767-4440"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "112 Vilseck Rd",
            "address_purpose": "LOCATION",
            "city": "Fort Stewart",
            "state": "GA",
            "postal_code": "31315",
            "country_code": "US",
            "telephone_number": "912-257-7056",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PACKARD",
        "first_name": "BRYAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-09-16",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN015155",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019.030304",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Earnestine Watson Otovo, M.D.
• Christopher Joseph Ott, M.D.
• Erickeya M Owens
• James Ozorkiewicz, PA-C
• Mika Ley Cyrus Pacifico, OTR
• Priscilla C Packnett, RD, LDN
• Selmman Ricardo Padridin
• Joel Henry Page III, PHARMACIST
• Floreyce Ann Palmer, ARNP
• Jonathan Alan Palmer, CRNA

• Dentist in Fort Stewart, GA
• Providers in Fort Stewart, GA by specialty
• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.