Provider Demographics
NPI:1891243721
Name:FERNS, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:FERNS
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 1:1771 NW BURDETT XING
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64015-1610
Mailing Address - Country:US
Mailing Address - Phone:816-228-0001
Mailing Address - Fax:
Practice Address - Street 1:1771 NW BURDETT XING
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-1610
Practice Address - Country:US
Practice Address - Phone:816-228-0001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-20
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018012462122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist