Provider Demographics
NPI:1922236850
Name:HART, RYAN T (DMD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:T
Last Name:HART
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:46750-2746
Mailing Address - Country:US
Mailing Address - Phone:260-356-6651
Mailing Address - Fax:260-356-7751
Practice Address - Street 1:429 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:IN
Practice Address - Zip Code:46750-2746
Practice Address - Country:US
Practice Address - Phone:260-356-6651
Practice Address - Fax:260-356-7751
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011333A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist