Provider Demographics
NPI:1013200054
Name:THOMAS, RYAN FITZGERALD (DDS)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:FITZGERALD
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5802 NOLENSVILLE PIKE STE 103
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-6540
Mailing Address - Country:US
Mailing Address - Phone:615-873-4495
Mailing Address - Fax:
Practice Address - Street 1:5802 NOLENSVILLE PIKE STE 103
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-6540
Practice Address - Country:US
Practice Address - Phone:615-873-4495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN99161223S0112X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program