Provider Demographics
NPI:1306039953
Name:TULL RYAN, LARA L (MS)
Entity Type:Individual
Prefix:DR
First Name:LARA
Middle Name:L
Last Name:TULL RYAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:DR
Other - First Name:LARA
Other - Middle Name:L
Other - Last Name:TULL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4601 W 109TH ST. SUITE 212
Mailing Address - Street 2:JOHNSON COUNTY PERIODONTICS
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211
Mailing Address - Country:US
Mailing Address - Phone:913-491-5548
Mailing Address - Fax:913-491-0793
Practice Address - Street 1:4601 W 109TH ST
Practice Address - Street 2:SUITE 212
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1318
Practice Address - Country:US
Practice Address - Phone:913-491-5548
Practice Address - Fax:913-491-0793
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60284122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist