Provider Demographics
NPI:1396058053
Name:THOMAS, RYAN E (DDS)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:E
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 N 300 W
Mailing Address - Street 2:SUITE 404
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-1878
Mailing Address - Country:US
Mailing Address - Phone:801-544-9444
Mailing Address - Fax:801-544-9443
Practice Address - Street 1:275 N 300 W
Practice Address - Street 2:SUITE 404
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-1878
Practice Address - Country:US
Practice Address - Phone:801-544-9444
Practice Address - Fax:801-544-9443
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT493670499221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1174626345OtherNPI