Individual
MERRIL BRYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
112 SIXTH AVE, PAGE, AZ 86040
(928) 645-3206
(928) 645-9139
Mailing address
PO BOX 1956, 112 SIXTH AVE, PAGE, AZ 86040
(928) 645-3206
(928) 645-9139
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D1527
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
084004
AHCCCS
AZ
Enumeration date
08/28/2006
Last updated
07/08/2007
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