Provider Demographics
NPI:1407532500
Name:GAFFNER, RYAN LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:LEE
Last Name:GAFFNER
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 1:15210 BRAETON DR APT 305
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-3292
Mailing Address - Country:US
Mailing Address - Phone:703-678-9925
Mailing Address - Fax:
Practice Address - Street 1:3250 ANDERSON HWY
Practice Address - Street 2:
Practice Address - City:POWHATAN
Practice Address - State:VA
Practice Address - Zip Code:23139-7307
Practice Address - Country:US
Practice Address - Phone:804-598-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401418535122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist