Provider Demographics
NPI:1457629198
Name:RYAN A DRAISS DMD LLC
Entity Type:Organization
Organization Name:RYAN A DRAISS DMD LLC
Other - Org Name:CHELSEA COMPREHENSIVE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DRAISS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-370-7499
Mailing Address - Street 1:407 CHELSEA CROSSROADS
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:AL
Mailing Address - Zip Code:35043-3901
Mailing Address - Country:US
Mailing Address - Phone:205-370-7499
Mailing Address - Fax:
Practice Address - Street 1:407 CHELSEA CROSSROADS
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:AL
Practice Address - Zip Code:35043-3901
Practice Address - Country:US
Practice Address - Phone:205-370-7499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL57811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty