Provider Demographics
NPI:1023451655
Name:RYSKALCZYK, MATTHEW (DMD, MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:RYSKALCZYK
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 N 185TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-4011
Mailing Address - Country:US
Mailing Address - Phone:206-542-1313
Mailing Address - Fax:
Practice Address - Street 1:1130 N 185TH ST STE 101
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-4011
Practice Address - Country:US
Practice Address - Phone:206-542-1313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-13
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60918839204E00000X
WADE610173841223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery