Provider Demographics
NPI:1104003102
Name:WING, RYAN SCHOFIELD (DDS)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:SCHOFIELD
Last Name:WING
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 1:497 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-3002
Mailing Address - Country:US
Mailing Address - Phone:801-798-2100
Mailing Address - Fax:801-798-9977
Practice Address - Street 1:497 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-3002
Practice Address - Country:US
Practice Address - Phone:801-798-2100
Practice Address - Fax:801-798-9977
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6679426-99221223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry