Provider Demographics
NPI:1467615716
Name:BERNARD E RYAN DDS PC
Entity Type:Organization
Organization Name:BERNARD E RYAN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-932-9695
Mailing Address - Street 1:9 BRIARCLIFF PROFESSIONAL CENTER
Mailing Address - Street 2:SUITE D
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-2429
Mailing Address - Country:US
Mailing Address - Phone:815-932-9695
Mailing Address - Fax:815-929-0582
Practice Address - Street 1:9 BRIARCLIFF PROF CTR SUITE D
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-2429
Practice Address - Country:US
Practice Address - Phone:815-932-9695
Practice Address - Fax:815-929-0582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019015907261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental