Provider Demographics
NPI:1235518796
Name:BURZESE, RYAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:BURZESE
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 1:108 VIP DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-7975
Mailing Address - Country:US
Mailing Address - Phone:724-935-0700
Mailing Address - Fax:
Practice Address - Street 1:1936 ASPEN CT
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:PA
Practice Address - Zip Code:15027-1363
Practice Address - Country:US
Practice Address - Phone:412-848-4418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-29
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PADS040809122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program