Provider Demographics
NPI:1043926314
Name:RYAN, JULIANA ROSA (DDS, MSC)
Entity Type:Individual
Prefix:DR
First Name:JULIANA
Middle Name:ROSA
Last Name:RYAN
Suffix:
Gender:F
Credentials:DDS, MSC
Other - Prefix:
Other - First Name:JULIANA
Other - Middle Name:ROSA ALONSO
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS, MSC
Mailing Address - Street 1:3355 BLACKBURN ST APT 9406
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-4510
Mailing Address - Country:US
Mailing Address - Phone:210-630-5321
Mailing Address - Fax:
Practice Address - Street 1:3302 GASTON AVE RM 317
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2013
Practice Address - Country:US
Practice Address - Phone:214-828-8144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38791122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist