Provider Demographics
NPI:1962039057
Name:DR. MATTHEW RYAN DENTAL PRACTICE CORPORATION
Entity Type:Organization
Organization Name:DR. MATTHEW RYAN DENTAL PRACTICE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:D
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-486-8255
Mailing Address - Street 1:4350 MARCONI AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-4379
Mailing Address - Country:US
Mailing Address - Phone:916-486-8255
Mailing Address - Fax:916-486-8266
Practice Address - Street 1:4350 MARCONI AVE STE 100
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-4379
Practice Address - Country:US
Practice Address - Phone:916-486-8255
Practice Address - Fax:916-486-8266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental