Provider Demographics
NPI:1871661819
Name:BYGNESS, RYAN E (DDS)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:E
Last Name:BYGNESS
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 1:2330 HIGHWAY 141
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:IA
Mailing Address - Zip Code:51442-7462
Mailing Address - Country:US
Mailing Address - Phone:712-263-8685
Mailing Address - Fax:
Practice Address - Street 1:1328 BROADWAY
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:IA
Practice Address - Zip Code:51442-1924
Practice Address - Country:US
Practice Address - Phone:712-263-3252
Practice Address - Fax:712-794-4142
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA079121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0210211Medicaid