Provider Demographics
NPI:1417348004
Name:RYAN R BOYLAN DDS PC
Entity Type:Organization
Organization Name:RYAN R BOYLAN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BOYLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-547-5105
Mailing Address - Street 1:528 ALBEMARLE DR
Mailing Address - Street 2:#200
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-5584
Mailing Address - Country:US
Mailing Address - Phone:757-547-5105
Mailing Address - Fax:
Practice Address - Street 1:528 ALBEMARLE DR
Practice Address - Street 2:#200
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-5584
Practice Address - Country:US
Practice Address - Phone:757-547-5105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-18
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty