Provider Demographics
NPI:1891958666
Name:BINGHAM, RYAN SEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:SEAN
Last Name:BINGHAM
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 1:1122 9TH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-6412
Mailing Address - Country:US
Mailing Address - Phone:970-353-2340
Mailing Address - Fax:970-353-2344
Practice Address - Street 1:1122 9TH ST STE 103
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-6412
Practice Address - Country:US
Practice Address - Phone:970-353-2340
Practice Address - Fax:970-353-2344
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9702122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist