Provider Demographics
NPI:1013103985
Name:REDIGER, RYAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:REDIGER
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 1:26875 US HIGHWAY 380 E STE 108
Mailing Address - Street 2:
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227-8063
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:26875 US HIGHWAY 380 E STE 108
Practice Address - Street 2:
Practice Address - City:AUBREY
Practice Address - State:TX
Practice Address - Zip Code:76227-8063
Practice Address - Country:US
Practice Address - Phone:940-305-0408
Practice Address - Fax:940-305-0396
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID4479122300000X
TX39035122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist