Provider Demographics
NPI:1689286619
Name:BRAMHALL, RYAN EUGENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:EUGENE
Last Name:BRAMHALL
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 1:1108 S MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-3325
Mailing Address - Country:US
Mailing Address - Phone:760-728-2261
Mailing Address - Fax:760-728-2313
Practice Address - Street 1:1108 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-3325
Practice Address - Country:US
Practice Address - Phone:760-728-2261
Practice Address - Fax:760-728-2313
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105340122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist