Provider Demographics
NPI:1942235296
Name:WILLDEN, RYAN HYMAS (DDS)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:HYMAS
Last Name:WILLDEN
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 1:3632 W. SOUTH JORDAN PARKWAY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-9339
Mailing Address - Country:US
Mailing Address - Phone:801-446-4668
Mailing Address - Fax:801-446-6037
Practice Address - Street 1:3632 W SOUTH JORDAN PKWY
Practice Address - Street 2:SUITE 202
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-7162
Practice Address - Country:US
Practice Address - Phone:801-446-4668
Practice Address - Fax:801-446-6037
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5326234 99221223G0001X
UT5326234 89031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice