Roger Lynn Bryant, D.D.S.
Individual provider Active NPI Dentist · Choctaw, OK
NPI 1629246152 · NPPES record last updated Feb 19, 2008
Key facts
- NPI
- 1629246152
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- OK4401-82 (OK)
- Practice address
- 14461 NE 23Rd Street
Choctaw, OK 73020-0715 - Phone
- (405) 390-8000
- Fax
- (405) 390-9933
- NPI assigned
- Feb 19, 2008
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OK4401-82 | OK | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | OK4401-82 | OK | Yes |
Addresses
Primary practice location
14461 NE 23Rd Street
Choctaw, OK 73020-0715
Mailing address
PO Box 715
Choctaw, OK 73020-0715
Phone (405) 390-8000
Other providers in Choctaw, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 19, 2008. 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.