Provider Demographics
NPI:1114170008
Name:NOAH, RYAN K (DDS)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:K
Last Name:NOAH
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 1:148 W MAIN ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:GLENPOOL
Mailing Address - State:OK
Mailing Address - Zip Code:74033-3962
Mailing Address - Country:US
Mailing Address - Phone:918-321-2000
Mailing Address - Fax:918-321-2766
Practice Address - Street 1:148 W MAIN ST
Practice Address - Street 2:SUITE D
Practice Address - City:GLENPOOL
Practice Address - State:OK
Practice Address - Zip Code:74033-3962
Practice Address - Country:US
Practice Address - Phone:918-321-2000
Practice Address - Fax:918-321-2766
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6070122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist