| NPI | 1912195942 |
|---|---|
| Former Name | TIARA BRYANT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA DENT.DE.60543431) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 4336) |
| Enumeration Date | 2007-10-03 |
| Last Update Date | 2015-08-06 |