Individual
HENRY GASSON BRYAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
20805 E 12 MILE RD, SUITE 110, ROSEVILLE, MI 48066-6502
(586) 778-2100
Mailing address
20805 E 12 MILE RD, SUITE 110, ROSEVILLE, MI 48066-6502
(586) 778-2100
(586) 778-2422
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
HB014814
MI
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
HB014814
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2932746
—
MI
Enumeration date
07/10/2006
Last updated
04/11/2008
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