Provider Demographics
NPI:1275696346
Name:RYAN L. BRITTINGHAM DDS PA
Entity Type:Organization
Organization Name:RYAN L. BRITTINGHAM DDS PA
Other - Org Name:LEGENDS DRIVE DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRITTINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:785-841-5590
Mailing Address - Street 1:4900 LEGENDS DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-3886
Mailing Address - Country:US
Mailing Address - Phone:785-841-5590
Mailing Address - Fax:785-856-2339
Practice Address - Street 1:4900 LEGENDS DR
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-3886
Practice Address - Country:US
Practice Address - Phone:785-841-5590
Practice Address - Fax:785-856-2339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1167861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty