Provider Demographics
NPI:1760645923
Name:RYAN, MICHAEL (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:RYAN
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 1:720 E MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-3105
Mailing Address - Country:US
Mailing Address - Phone:972-727-5001
Mailing Address - Fax:972-727-6335
Practice Address - Street 1:720 E MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-3105
Practice Address - Country:US
Practice Address - Phone:972-727-5001
Practice Address - Fax:972-727-6335
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22742122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist