Provider Demographics
NPI:1568073294
Name:CODY, RYAN JAMES
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:JAMES
Last Name:CODY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7900 CAMBRIDGE ST APT 17-1I
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-5548
Mailing Address - Country:US
Mailing Address - Phone:207-347-0007
Mailing Address - Fax:
Practice Address - Street 1:7906 GULF FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77017-3018
Practice Address - Country:US
Practice Address - Phone:713-396-3844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-15
Last Update Date:2020-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice