Provider Demographics
NPI:1003251455
Name:PEACE, RYAN H (DMD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:H
Last Name:PEACE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2865 RING RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-9114
Mailing Address - Country:US
Mailing Address - Phone:270-765-7212
Mailing Address - Fax:270-769-3797
Practice Address - Street 1:2865 RING RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-9114
Practice Address - Country:US
Practice Address - Phone:270-765-7212
Practice Address - Fax:270-769-3797
Is Sole Proprietor?:No
Enumeration Date:2013-04-29
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY93371223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program