Provider Demographics
NPI:1306041645
Name:RYAN, PATRICK BENDON (DDS)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:BENDON
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 1:2516 FORUM BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-5405
Mailing Address - Country:US
Mailing Address - Phone:573-446-6662
Mailing Address - Fax:
Practice Address - Street 1:2516 FORUM BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-5405
Practice Address - Country:US
Practice Address - Phone:573-446-6662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006014447122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist