Provider Demographics
NPI:1083824544
Name:MOLIS, RYAN J (DDS)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:J
Last Name:MOLIS
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 1:16W375 83RD ST
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5841
Mailing Address - Country:US
Mailing Address - Phone:630-920-1990
Mailing Address - Fax:630-920-9715
Practice Address - Street 1:16W375 83RD ST
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-5841
Practice Address - Country:US
Practice Address - Phone:630-920-1990
Practice Address - Fax:630-920-9715
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice