Provider Demographics
NPI:1457432866
Name:RYAN, ROBERT N
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:N
Last Name:RYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 SALEM ST
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-5536
Mailing Address - Country:US
Mailing Address - Phone:530-895-3732
Mailing Address - Fax:530-895-0905
Practice Address - Street 1:555 SALEM ST
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-5536
Practice Address - Country:US
Practice Address - Phone:530-895-3732
Practice Address - Fax:530-895-0905
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2025-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAK06017391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice