David Wayne Bryant, DDS
Individual provider Active NPI Dentist · Alamosa, CO
NPI 1528329752 · NPPES record last updated Jun 5, 2012
Key facts
- NPI
- 1528329752
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DEN-10632 (CO)
- Practice address
- 128 Market St
Alamosa Dental Clinic
Alamosa, CO 81101 - Phone
- (719) 589-9691
- NPI assigned
- Jun 5, 2012
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160331002339 | TX | Order and Referring Only - Dentist |
8729392303 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DEN-10632 | CO | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DEN-10632 | CO | Yes |
Addresses
Primary practice location
128 Market St
Alamosa Dental Clinic
Alamosa, CO 81101
Mailing address
128 Market St
Alamosa Dental Clinic
Alamosa, CO 81101
Phone (719) 589-9691
Other providers in Alamosa, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 5, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.