Provider Demographics
NPI:1407948136
Name:RYE, DEAN GORDON (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:GORDON
Last Name:RYE
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 1:10614 WARWICK AVE STE A
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-3060
Mailing Address - Country:US
Mailing Address - Phone:703-352-2010
Mailing Address - Fax:703-591-9408
Practice Address - Street 1:10614 WARWICK AVE STE A
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-3060
Practice Address - Country:US
Practice Address - Phone:703-352-2010
Practice Address - Fax:703-591-9408
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010061351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice