Individual
DR. KEITH ANDREW BRYANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
4224 S STATE ROUTE 159, SUITE 1, GLEN CARBON, IL 62034-3201
(618) 288-6227
(618) 288-6472
Mailing address
4224 S STATE ROUTE 159, SUITE 1, GLEN CARBON, IL 62034-3201
(618) 288-6227
(618) 288-6472
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
871019
UNITED CONCORDIA
IL
Enumeration date
12/11/2006
Last updated
07/08/2007
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