Provider Demographics
NPI:1992035117
Name:RYALS, STANLEY C (DMD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:C
Last Name:RYALS
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 1:404 TRIBBLE GAP RD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2442
Mailing Address - Country:US
Mailing Address - Phone:770-887-0480
Mailing Address - Fax:
Practice Address - Street 1:404 TRIBBLE GAP RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2442
Practice Address - Country:US
Practice Address - Phone:770-887-0480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA402421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice