Provider Demographics
NPI:1558610113
Name:RYAN S. BINGHAM DDS, PC
Entity Type:Organization
Organization Name:RYAN S. BINGHAM DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:SEAN
Authorized Official - Last Name:BINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-353-2340
Mailing Address - Street 1:1122 9TH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-6412
Mailing Address - Country:US
Mailing Address - Phone:970-353-2340
Mailing Address - Fax:370-353-2344
Practice Address - Street 1:1122 9TH ST STE 103
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-6412
Practice Address - Country:US
Practice Address - Phone:970-353-2340
Practice Address - Fax:370-353-2344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO97021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty