Provider Demographics
NPI:1255474532
Name:TEAL, JAMES RYAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RYAN
Last Name:TEAL
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 1:11835 CARMEL MTN RD
Mailing Address - Street 2:#1306
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128
Mailing Address - Country:US
Mailing Address - Phone:858-485-5552
Mailing Address - Fax:858-485-1033
Practice Address - Street 1:11835 CARMEL MTN RD
Practice Address - Street 2:#1306
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128
Practice Address - Country:US
Practice Address - Phone:858-485-5552
Practice Address - Fax:858-485-1033
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28248122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist