Provider Demographics
NPI:1437268794
Name:DETMER, RYAN M (DDS)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:M
Last Name:DETMER
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 1:5024 ALDINE DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-6210
Mailing Address - Country:US
Mailing Address - Phone:513-533-0405
Mailing Address - Fax:513-870-3064
Practice Address - Street 1:2760 MACK RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5129
Practice Address - Country:US
Practice Address - Phone:513-874-2444
Practice Address - Fax:513-870-3064
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0223671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice