| NPI | 1538644471 |
|---|---|
| Former Name | DESIREE NICOLE BRYANT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CT 12817) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NY 060129) |
| Enumeration Date | 2018-09-26 |
| Last Update Date | 2020-07-23 |