Provider Demographics
NPI:1326230731
Name:MOONEY, RYAN PATRICK (DDS)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:PATRICK
Last Name:MOONEY
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 1:23535 IH 10 W
Mailing Address - Street 2:SUITE 2202
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-1668
Mailing Address - Country:US
Mailing Address - Phone:210-687-1444
Mailing Address - Fax:
Practice Address - Street 1:23535 IH 10 W
Practice Address - Street 2:SUITE 2202
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-1668
Practice Address - Country:US
Practice Address - Phone:210-687-1444
Practice Address - Fax:210-687-1445
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2009-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX233441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice