| O'bryan Dental Clinic | |
|
6181 Highway 18 Brandon MS 39042-8296 | |
| (601) 825-0559 | |
| (601) 825-0374 |
| Full Name | O'bryan Dental Clinic |
|---|---|
| Speciality | Dentist |
| Location | 6181 Highway 18, Brandon, Mississippi |
| Authorized Official Name and Position | Tanya M O'bryan (OWNER/DENTIST) |
| Authorized Official Contact | 6018250559 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| O'bryan Dental Clinic 6181 Highway 18 Brandon MS 39042-8296 Ph: (601) 825-0559 | O'bryan Dental Clinic 6181 Highway 18 Brandon MS 39042-8296 Ph: (601) 825-0559 |
| NPI Number | 1639424963 |
|---|---|
| Provider Enumeration Date | 07/24/2012 |
| Last Update Date | 07/24/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639424963 | NPI | - | NPPES |
| 08533712 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 318201 (Mississippi) | Primary |
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