Provider Demographics
NPI:1669821146
Name:RYAN, JOSEPH KEVIN
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:KEVIN
Last Name:RYAN
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 1:4900 N 10TH ST STE F2
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2781
Mailing Address - Country:US
Mailing Address - Phone:956-687-2004
Mailing Address - Fax:
Practice Address - Street 1:4900 N 10TH ST STE F2
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2781
Practice Address - Country:US
Practice Address - Phone:956-687-2004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX303171223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics