Provider Demographics
NPI:1902215429
Name:RYAN, ERICKA (DDS)
Entity Type:Individual
Prefix:MRS
First Name:ERICKA
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ERICKA
Other - Middle Name:
Other - Last Name:BUYCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15300 I.H. 35 #300
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610
Mailing Address - Country:US
Mailing Address - Phone:512-523-8183
Mailing Address - Fax:
Practice Address - Street 1:15300 I.H. 35 #300
Practice Address - Street 2:
Practice Address - City:BUDA
Practice Address - State:TX
Practice Address - Zip Code:78610
Practice Address - Country:US
Practice Address - Phone:512-523-8183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-08
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX366631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY057428OtherNY STATE DENTAL LICENSE