Provider Demographics
NPI:1225100647
Name:RYDESKY, JR., STEPHEN M (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:M
Last Name:RYDESKY, JR.
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 E TRINDLE RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-3622
Mailing Address - Country:US
Mailing Address - Phone:717-766-2552
Mailing Address - Fax:717-766-6572
Practice Address - Street 1:5005 E TRINDLE RD
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-3622
Practice Address - Country:US
Practice Address - Phone:717-766-2552
Practice Address - Fax:717-766-6572
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-016980-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADS-016980-LOtherLICENSE NUMBER
PAAR2409527OtherDEA NUMBER