Samuel David Bryner, DMD
Individual provider Active NPI Dentist · Blackwell, OK
NPI 1336973403 · NPPES record last updated Sep 6, 2024
Key facts
- NPI
- 1336973403
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 7950 (OK)
- Practice address
- 1520 S Main St
Blackwell, OK 74631-4921 - Phone
- (580) 262-8420
- NPI assigned
- Aug 29, 2024
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 7950 | OK | Yes |
Addresses
Primary practice location
1520 S Main St
Blackwell, OK 74631-4921
Mailing address
1520 S Main St
Blackwell, OK 74631-4921
Phone (580) 262-8420
Other providers in Blackwell, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 6, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.