Provider Demographics
NPI:1760467476
Name:WAYLAND, RYAN C (DMD, PROSTHODONTIS)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:C
Last Name:WAYLAND
Suffix:
Gender:M
Credentials:DMD, PROSTHODONTIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 PROVIDENCE DR
Mailing Address - Street 2:SUITE 560 PROVIDENCE MEDICAL OFFICE BUILDING
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4643
Mailing Address - Country:US
Mailing Address - Phone:907-631-6070
Mailing Address - Fax:
Practice Address - Street 1:3340 PROVIDENCE DR
Practice Address - Street 2:SUITE 560 PROVIDENCE MEDICAL OFFICE BUILDING
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4643
Practice Address - Country:US
Practice Address - Phone:907-631-6070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK12411223G0001X
KY76801223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223P0700XDental ProvidersDentistProsthodontics