Provider Demographics
NPI:1710141213
Name:RYAN, MARIA EMANUEL (DDS, PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:EMANUEL
Last Name:RYAN
Suffix:
Gender:F
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:LAUREL HOLLOW
Mailing Address - State:NY
Mailing Address - Zip Code:11791
Mailing Address - Country:US
Mailing Address - Phone:516-692-4379
Mailing Address - Fax:
Practice Address - Street 1:STONY BROOK UNIVERSITY SDM
Practice Address - Street 2:WESTCHESTER HALL, DEPT OF OB&P
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-632-9529
Practice Address - Fax:631-932-9705
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04480911223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics