Provider Demographics
NPI:1992357651
Name:WAINWRIGHT, RYAN CARTER (DMD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:CARTER
Last Name:WAINWRIGHT
Suffix:
Gender:M
Credentials:DMD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:COMMANDING OFFICER 2D DENBN/NDC PSC 20130
Mailing Address - Street 2:315 MCHUGH BLVD
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28542-0130
Mailing Address - Country:US
Mailing Address - Phone:910-451-2208
Mailing Address - Fax:910-451-8479
Practice Address - Street 1:COMMANDING OFFICER 2D DENBN/NDC PSC 20130
Practice Address - Street 2:315 MCHUGH BLVD
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28542-0130
Practice Address - Country:US
Practice Address - Phone:910-451-2208
Practice Address - Fax:910-451-8479
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11345601-9921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist