Provider Demographics
NPI:1134820061
Name:CARRERA, RYAN
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:CARRERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23076 THREE NOTCH RD STE 203
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:MD
Mailing Address - Zip Code:20619-2491
Mailing Address - Country:US
Mailing Address - Phone:240-349-5000
Mailing Address - Fax:
Practice Address - Street 1:23076 THREE NOTCH RD STE 203
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:MD
Practice Address - Zip Code:20619-2491
Practice Address - Country:US
Practice Address - Phone:240-349-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-16
Last Update Date:2025-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18585122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentistGroup - Single Specialty