Provider Demographics
NPI:1255031464
Name:RODEF, RYAN JOSEPH (DMD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:JOSEPH
Last Name:RODEF
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 S BARRINGTON AVE # 214
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-3310
Mailing Address - Country:US
Mailing Address - Phone:310-975-9953
Mailing Address - Fax:
Practice Address - Street 1:2233 E GARVEY AVE N
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791-1500
Practice Address - Country:US
Practice Address - Phone:626-966-3033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-07
Last Update Date:2025-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA111393122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program