Organization
MAPLE LEAF IMPLANT AND GENERAL DENTISTRY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERALD A BRYANT DDS (DENTIST)
(931) 526-2613
Entity
Organization
Contact information
Practice address
220 N WASHINGTON AVE, COOKEVILLE, TN 38501-2642
(931) 526-2613
(931) 646-0901
Mailing address
220 N WASHINGTON AVE, COOKEVILLE, TN 38501-2642
(931) 526-2613
(931) 646-0901
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7879
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q009025
—
TN
Enumeration date
01/26/2011
Last updated
02/15/2016
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