Provider Demographics
NPI:1942525720
Name:RYAN HANRY, DDS, PA
Entity Type:Organization
Organization Name:RYAN HANRY, DDS, PA
Other - Org Name:SOUTH ARKANSAS PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PEDIATRIC DENTIST/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:WARNER
Authorized Official - Last Name:HANRY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:870-862-4543
Mailing Address - Street 1:347 W OAK ST STE B
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-4564
Mailing Address - Country:US
Mailing Address - Phone:870-862-4543
Mailing Address - Fax:870-862-4542
Practice Address - Street 1:347 W OAK ST STE B
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4564
Practice Address - Country:US
Practice Address - Phone:870-862-4543
Practice Address - Fax:870-862-4542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-05
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR36281223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty