Provider Demographics
NPI:1003009903
Name:VANLAECKEN, RYAN K (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:K
Last Name:VANLAECKEN
Suffix:
Gender:M
Credentials:DDS MS
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Mailing Address - Street 1:25 5TH ST NE
Mailing Address - Street 2:P O BOX 1450
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-3712
Mailing Address - Country:US
Mailing Address - Phone:605-882-1500
Mailing Address - Fax:605-882-7090
Practice Address - Street 1:600 4TH ST NE STE 103
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-1898
Practice Address - Country:US
Practice Address - Phone:605-882-1500
Practice Address - Fax:605-882-7090
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2020-05-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SDM8171223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics