Provider Demographics
NPI:1356612188
Name:RYAN DENTAL LLC
Entity type:Organization
Organization Name:RYAN DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:913-764-5703
Mailing Address - Street 1:12710 S PFLUMM RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-3882
Mailing Address - Country:US
Mailing Address - Phone:913-764-5703
Mailing Address - Fax:913-764-6603
Practice Address - Street 1:12710 S PFLUMM RD
Practice Address - Street 2:SUITE 210
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-3882
Practice Address - Country:US
Practice Address - Phone:913-764-5703
Practice Address - Fax:913-764-6603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS70341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty