Provider Demographics
NPI:1568625853
Name:RYAN W. WHITMAN FAMILY & COSMETIC DENTISTRY, PLLC
Entity Type:Organization
Organization Name:RYAN W. WHITMAN FAMILY & COSMETIC DENTISTRY, PLLC
Other - Org Name:DURANGO FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:TENNILLE
Authorized Official - Last Name:WHITMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-671-8839
Mailing Address - Street 1:1165 S CAMINO DEL RIO STE 300
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81303-6824
Mailing Address - Country:US
Mailing Address - Phone:970-382-8111
Mailing Address - Fax:970-385-4529
Practice Address - Street 1:1165 S CAMINO DEL RIO STE 300
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303-6824
Practice Address - Country:US
Practice Address - Phone:970-382-8111
Practice Address - Fax:970-385-4529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-07
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00202133261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty