Provider Demographics
NPI:1184284127
Name:RYAN D BLISSETT, DMD, PC
Entity type:Organization
Organization Name:RYAN D BLISSETT, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROSTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:BLISSETT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-217-1022
Mailing Address - Street 1:822 BOYLSTON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-2504
Mailing Address - Country:US
Mailing Address - Phone:617-606-3852
Mailing Address - Fax:
Practice Address - Street 1:822 BOYLSTON ST STE 200
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-2504
Practice Address - Country:US
Practice Address - Phone:617-606-3852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty