Provider Demographics
NPI:1487830774
Name:MATHERNE, RYAN PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:PAUL
Last Name:MATHERNE
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 1:132 SUGARMILL RD
Mailing Address - Street 2:
Mailing Address - City:MATHEWS
Mailing Address - State:LA
Mailing Address - Zip Code:70375-2037
Mailing Address - Country:US
Mailing Address - Phone:985-532-5283
Mailing Address - Fax:
Practice Address - Street 1:170 MOORES RD
Practice Address - Street 2:SUITE A
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-2916
Practice Address - Country:US
Practice Address - Phone:985-727-0991
Practice Address - Fax:985-727-0994
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA51201223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics