Provider Demographics
NPI:1689155046
Name:MAGNUSON, RYAN WESLEY
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:WESLEY
Last Name:MAGNUSON
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 1:2745 DELTA OAKS DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408-1700
Mailing Address - Country:US
Mailing Address - Phone:541-343-2735
Mailing Address - Fax:
Practice Address - Street 1:2745 DELTA OAKS DR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97408-1700
Practice Address - Country:US
Practice Address - Phone:541-343-2735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD108181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice