Provider Demographics
NPI:1265477095
Name:RYAN, WILLIAM ALOVSIUS (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ALOVSIUS
Last Name:RYAN
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 1:429 KELLER PKWY
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-2302
Mailing Address - Country:US
Mailing Address - Phone:817-431-1622
Mailing Address - Fax:817-431-8879
Practice Address - Street 1:429 KELLER PKWY
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-2302
Practice Address - Country:US
Practice Address - Phone:817-431-1622
Practice Address - Fax:817-431-8879
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX148901223G0001X, 1223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223D0004XDental ProvidersDentistDentist Anesthesiologist