Provider Demographics
NPI:1821473620
Name:FORT, RYAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:FORT
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 1:21 CR 308
Mailing Address - Street 2:
Mailing Address - City:MUENSTER
Mailing Address - State:TX
Mailing Address - Zip Code:76252
Mailing Address - Country:US
Mailing Address - Phone:832-217-9671
Mailing Address - Fax:
Practice Address - Street 1:2515 E ELLIOTT ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308
Practice Address - Country:US
Practice Address - Phone:940-696-9701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-22
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXETN355390200000X
TX32827122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program