# EMORY W. BRYAN, JR.,D.D.S., P.C.

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417008947
- **Authorized official:** DR. EMORY WALLACE BRYAN JR. D.D.S. (PRESIDENT)
- **Authorized official phone:** (260) 485-9142

## Contact information

- **Practice address:** 6427 GEORGETOWN NORTH BLVD, FORT WAYNE, IN 46815-7007
- **Practice address phone:** (260) 485-9142
- **Practice address fax:** (260) 485-9783
- **Mailing address:** 6427 GEORGETOWN NORTH BLVD, FORT WAYNE, IN 46815-7007
- **Mailing address phone:** (260) 485-9142
- **Mailing address fax:** (260) 485-9783

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 54000568A | IN | Yes |

## Other

- **Enumeration date:** 01/12/2007
- **Last updated:** 08/22/2020