Provider Demographics
NPI:1295048361
Name:RYAN, MEGAN (DMD)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 RED CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-2332
Mailing Address - Country:US
Mailing Address - Phone:715-233-6800
Mailing Address - Fax:
Practice Address - Street 1:404 RED CEDAR ST
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-2332
Practice Address - Country:US
Practice Address - Phone:715-233-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN4151122300000X
MADN1855663122300000X
WI7147-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist