Provider Demographics
NPI:1225083553
Name:TENNANT, RYAN M (DDS)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:M
Last Name:TENNANT
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 1:3257 26TH AVE W
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98199-2823
Mailing Address - Country:US
Mailing Address - Phone:206-240-6415
Mailing Address - Fax:206-352-3962
Practice Address - Street 1:200 W MERCER ST
Practice Address - Street 2:STE. 205
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-3995
Practice Address - Country:US
Practice Address - Phone:206-281-8300
Practice Address - Fax:206-281-0075
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE102861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice