Bryan Pediatric Dentistry

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

BRYAN PEDIATRIC DENTISTRY

Practice address

2510 S Texas Ave
Bryan, TX 77802-2329

Phone

(317) 903-9276

NPI assigned

Jul 26, 2017

Organization subpart

No

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

Authorized official

Name

Kristine Donnelly, DDSNPI 1104016344

Title

Owner, Pediatric Dentist

Phone

(979) 703-2893

Specialties & licenses 1

Addresses

Other names 1

• Bryan Pediatric Dentistry PC Other name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kristine Donnelly, D.D.S.

  • Pediatric Dentistry
  • Bryan, TX
  • NPI 1104016344
  NPD Authorized official

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

{
    "created_epoch": "1501027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718150400000",
    "number": "1891219499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1709 GLADE ST",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778404341",
            "telephone_number": "317-903-9276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2510 S TEXAS AVE",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778022329",
            "telephone_number": "317-903-9276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRYAN PEDIATRIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-26",
        "last_updated": "2024-06-12",
        "certification_date": "2024-06-12",
        "status": "A",
        "authorized_official_last_name": "DONNELLY",
        "authorized_official_first_name": "KRISTINE",
        "authorized_official_title_or_position": "OWNER,  PEDIATRIC DENTIST",
        "authorized_official_telephone_number": "979-703-2893",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bryan Pediatric Dentistry PC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Bryan Kidney Center PLLC
• Bryan Medical Associates Medical Association
• Bryan Medical Center, LLC (SignatureCare Medical Center - Bryan)
• Bryan Modern Dentistry, PC (Bryan Modern Dentistry)
• Bryan Opco LLC (Legacy Nursing and Rehabilitation)
• Bryan Radiology Associates
• Bryan Radiology Associates
• Bryan SNF, LLC (Isle at Watercrest-Bryan)
• Bryan Texas Primary Clinic PLLC
• Bryan Total Vision Care

• Pediatric Dentistry in Bryan, TX
• Providers in Bryan, TX by specialty
• Pediatric Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2024; 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.