Provider Demographics
NPI:1407190523
Name:STENVALL, RYAN MARK (DMD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:MARK
Last Name:STENVALL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 ROUTE 10 WEST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:LEDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07852
Mailing Address - Country:US
Mailing Address - Phone:973-598-0800
Mailing Address - Fax:
Practice Address - Street 1:410 ROUTE 10 WEST
Practice Address - Street 2:SUITE 209
Practice Address - City:LEDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07852
Practice Address - Country:US
Practice Address - Phone:973-598-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI025205001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice