Provider Demographics
NPI:1861682783
Name:RYAN, JEFFREY LLOYD (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LLOYD
Last Name:RYAN
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1900 KRUTCHEN COURT SOUTH
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377
Mailing Address - Country:US
Mailing Address - Phone:320-656-1456
Mailing Address - Fax:320-656-0195
Practice Address - Street 1:1900 KRUTCHEN COURT SOUTH
Practice Address - Street 2:SUITE 100
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377
Practice Address - Country:US
Practice Address - Phone:320-656-1456
Practice Address - Fax:320-656-0195
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117901223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics