Provider Demographics
NPI:1770657835
Name:BREASBOIS, RYAN
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:BREASBOIS
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 1:204 W GRAND RIVER AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-2299
Mailing Address - Country:US
Mailing Address - Phone:517-546-9190
Mailing Address - Fax:517-546-9690
Practice Address - Street 1:204 W GRAND RIVER AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-2299
Practice Address - Country:US
Practice Address - Phone:517-546-9190
Practice Address - Fax:517-546-9690
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901017232122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist