Provider Demographics
NPI:1205961042
Name:RYAN, LAWRENCE P (DDS,MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:P
Last Name:RYAN
Suffix:
Gender:M
Credentials:DDS,MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11 S MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MARLBOROUGH
Mailing Address - State:CT
Mailing Address - Zip Code:06447-1553
Mailing Address - Country:US
Mailing Address - Phone:860-295-8780
Mailing Address - Fax:860-295-0875
Practice Address - Street 1:11 S MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MARLBOROUGH
Practice Address - State:CT
Practice Address - Zip Code:06447-1553
Practice Address - Country:US
Practice Address - Phone:860-295-8780
Practice Address - Fax:860-295-0875
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0075291223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT020007529CT07OtherANTHEM BLUE CROSS
TX4332423OtherAETNA
CT007529OtherCONNECTICARE INSURANCE
NJ207529OtherDELTA
PA0418117OtherCIGNA
TN204861OtherCIGNA DENTAL HEALTH
TX4332423OtherAETNA