Provider Demographics
NPI:1891004818
Name:RYAN M. DETMER D.D.S. INC.
Entity Type:Organization
Organization Name:RYAN M. DETMER D.D.S. INC.
Other - Org Name:BLUE ASH DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DETMER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:513-891-8555
Mailing Address - Street 1:4866 COOPER RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-6904
Mailing Address - Country:US
Mailing Address - Phone:513-891-8555
Mailing Address - Fax:513-891-8704
Practice Address - Street 1:4866 COOPER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-6904
Practice Address - Country:US
Practice Address - Phone:513-891-8555
Practice Address - Fax:513-891-8704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0223671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty