Provider Demographics
NPI:1063461341
Name:THOMAS, RYAN C (DDS)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:C
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 1:4059 W HUNT HWY STE 2
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85144-3858
Mailing Address - Country:US
Mailing Address - Phone:480-672-2525
Mailing Address - Fax:480-672-2528
Practice Address - Street 1:4059 W HUNT HWY STE 2
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85144-3858
Practice Address - Country:US
Practice Address - Phone:480-672-2525
Practice Address - Fax:480-672-2528
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0109061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30304124Medicaid