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Organization
RENAISSANCE ORAL SURGERY PC
Active
Organization
RENAISSANCE ORAL SURGERY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. HENRY BRYAN DDS (PRESIDENT)
(586) 778-2100
Entity
Organization
Contact information
Practice address
20805 E 12 MILE RD, STE 110, ROSEVILLE, MI 48066
(586) 778-2100
(586) 778-2422
Mailing address
20805 E 12 MILE RD, STE 110, ROSEVILLE, MI 48066
(586) 778-2100
(586) 778-2422
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
—
NULL
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
—
—
2082S0099X
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
—
NULL
2082S0099X
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
—
—
Other
Enumeration date
09/21/2007
Last updated
10/01/2013
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