Provider Demographics
NPI:1689126914
Name:GUMBERT, RYANNE (RDH)
Entity Type:Individual
Prefix:
First Name:RYANNE
Middle Name:
Last Name:GUMBERT
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:RYANNE
Other - Middle Name:
Other - Last Name:STROUTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:5305 HUNT RD
Mailing Address - Street 2:
Mailing Address - City:ONONDAGA
Mailing Address - State:MI
Mailing Address - Zip Code:49264-9712
Mailing Address - Country:US
Mailing Address - Phone:517-358-0784
Mailing Address - Fax:
Practice Address - Street 1:122 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-9164
Practice Address - Country:US
Practice Address - Phone:517-740-5620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902016239124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist