Provider Demographics
NPI:1225318264
Name:RYAN K. STAEHLING, DDS, PLLC
Entity Type:Organization
Organization Name:RYAN K. STAEHLING, DDS, PLLC
Other - Org Name:SOUTHERN DENTAL ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER, MANAGER, AND ORGANIZER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:STAEHLING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:225-802-1345
Mailing Address - Street 1:6500 CREEDMOOR RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-3697
Mailing Address - Country:US
Mailing Address - Phone:919-706-0565
Mailing Address - Fax:919-706-0564
Practice Address - Street 1:6500 CREEDMOOR RD
Practice Address - Street 2:SUITE 204
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-3697
Practice Address - Country:US
Practice Address - Phone:919-706-0565
Practice Address - Fax:919-706-0564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-22
Last Update Date:2011-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC88961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty