Provider Demographics
NPI:1013107317
Name:CHRISTIE, RICHARD RYAN (DDS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:RYAN
Last Name:CHRISTIE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 730
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-0730
Mailing Address - Country:US
Mailing Address - Phone:307-587-6249
Mailing Address - Fax:
Practice Address - Street 1:1619 S PARK DR
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-4330
Practice Address - Country:US
Practice Address - Phone:307-587-6249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY7721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice