Active NPI
Edwin C Bryson III, DDS
- Endodontics
- Charlotte, NC
National Provider Identifier
1285780791
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 6956
- Practice address
- 130 Providence Road
Charlotte, NC 28207 - Phone
- (704) 377-1444
- Fax
- (704) 377-1451
- NPI assigned
- Jan 26, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 6956 | NC | Primary |
Addresses
Primary practice location
130 Providence Road
Charlotte, NC 28207
Mailing address
130 Providence Road
Charlotte, NC 28207
Phone (704) 377-1444
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 89902C8 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Feb 2, 2016 through Feb 2, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6956 | NC | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1285780791",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "130 PROVIDENCE ROAD",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "28207",
"telephone_number": "704-377-1444",
"fax_number": "704-377-1451"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 PROVIDENCE ROAD",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "28207",
"telephone_number": "704-377-1444",
"fax_number": "704-377-1451"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRYSON",
"first_name": "EDWIN",
"middle_name": "C",
"name_suffix": "III",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "NC",
"license": "6956",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "89902C8",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.