Provider Demographics
NPI:1184901860
Name:RYAN DENTAL GROUP PA
Entity type:Organization
Organization Name:RYAN DENTAL GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-727-5001
Mailing Address - Street 1:1650 E STACY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-8778
Mailing Address - Country:US
Mailing Address - Phone:972-727-5001
Mailing Address - Fax:214-644-0077
Practice Address - Street 1:1650 E STACY RD STE 100
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-8778
Practice Address - Country:US
Practice Address - Phone:972-727-5001
Practice Address - Fax:214-644-0077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-09
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty