Provider Demographics
NPI:1972169704
Name:RYAN, KASEY MERRITT (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:KASEY
Middle Name:MERRITT
Last Name:RYAN
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10696 SUNBEAM CIR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-1905
Mailing Address - Country:US
Mailing Address - Phone:317-828-3415
Mailing Address - Fax:
Practice Address - Street 1:3905 N WHEELING AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-1769
Practice Address - Country:US
Practice Address - Phone:765-326-4389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-16
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013133A1223P0221X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry