Provider Demographics
NPI:1164984571
Name:RYAN, MARILIA (DDS)
Entity Type:Individual
Prefix:
First Name:MARILIA
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6320 CAPITAL BLVD STE 121
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-3017
Mailing Address - Country:US
Mailing Address - Phone:919-981-7363
Mailing Address - Fax:919-981-0679
Practice Address - Street 1:6320 CAPITAL BLVD STE 121
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-3017
Practice Address - Country:US
Practice Address - Phone:919-981-7363
Practice Address - Fax:919-981-0679
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-03
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1035391223G0001X
NC124891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice