Provider Demographics
NPI:1114461134
Name:CHENAUSKY, RYAN AUGUST (DDS)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:AUGUST
Last Name:CHENAUSKY
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 1:1624 LEE TREVINO DRIVE STE A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-5100
Mailing Address - Country:US
Mailing Address - Phone:915-593-8815
Mailing Address - Fax:915-593-8857
Practice Address - Street 1:1624 N. LEE TREVINO
Practice Address - Street 2:SUITE A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-5100
Practice Address - Country:US
Practice Address - Phone:915-593-8815
Practice Address - Fax:915-593-8857
Is Sole Proprietor?:No
Enumeration Date:2016-12-09
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX322431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice