Provider Demographics
NPI:1407976095
Name:ETUE, RYAN II
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:ETUE
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 SE EVERETT MALL WAY
Mailing Address - Street 2:SUITE 18
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-3250
Mailing Address - Country:US
Mailing Address - Phone:425-513-1993
Mailing Address - Fax:425-513-2132
Practice Address - Street 1:305 SE EVERETT MALL WAY
Practice Address - Street 2:SUITE 18
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-3250
Practice Address - Country:US
Practice Address - Phone:425-513-1993
Practice Address - Fax:425-513-2132
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD86481223G0001X
WADE000109771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice