Provider Demographics
NPI:1669467171
Name:RYAN, WILLIAM ROSS (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ROSS
Last Name:RYAN
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 1:1200 NW 149TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-1518
Mailing Address - Country:US
Mailing Address - Phone:405-401-8858
Mailing Address - Fax:
Practice Address - Street 1:13912 N. WESTERN
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013
Practice Address - Country:US
Practice Address - Phone:405-840-5591
Practice Address - Fax:405-840-5542
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2022-04-06
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-04-13
Provider Licenses
StateLicense IDTaxonomies
OK48591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice