Provider Demographics
NPI:1245072248
Name:RYAN MARINER DDS LLC
Entity type:Organization
Organization Name:RYAN MARINER DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARINER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:443-880-0654
Mailing Address - Street 1:9835 WINDING TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:OCEAN CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21842-9332
Mailing Address - Country:US
Mailing Address - Phone:443-880-0654
Mailing Address - Fax:
Practice Address - Street 1:9835 WINDING TRAIL DR
Practice Address - Street 2:
Practice Address - City:OCEAN CITY
Practice Address - State:MD
Practice Address - Zip Code:21842-9332
Practice Address - Country:US
Practice Address - Phone:443-880-0654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty