Individual
BRYAN A LARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
110 AUSTON WOODS CIR, APT U, EASLEY, SC 29640-4301
(864) 243-7534
Mailing address
1100 FLORIDA AVE, NEW ORLEANS, LA 70119-2715
(864) 386-0273
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
P-183
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/15/2015
Last updated
10/22/2019
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