Organization
O'BRYAN DENTAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TANYA M O'BRYAN DMD (OWNER/DENTIST)
(601) 825-0559
Entity
Organization
Contact information
Practice address
6181 HIGHWAY 18, BRANDON, MS 39042-8296
(601) 825-0559
(601) 825-0374
Mailing address
6181 HIGHWAY 18, BRANDON, MS 39042-8296
(601) 825-0559
(601) 825-0374
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
318201
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08533712
—
MS
Enumeration date
07/24/2012
Last updated
07/24/2012
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