Provider Demographics
NPI:1477041036
Name:JENNIFER RYAN, DDS, MS, INC.
Entity type:Organization
Organization Name:JENNIFER RYAN, DDS, MS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:530-878-8083
Mailing Address - Street 1:16860 LAYS LAKE ESTATES LN
Mailing Address - Street 2:
Mailing Address - City:MEADOW VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:95722-9333
Mailing Address - Country:US
Mailing Address - Phone:530-878-8083
Mailing Address - Fax:530-878-3910
Practice Address - Street 1:16814 PLACER HILLS RD
Practice Address - Street 2:
Practice Address - City:MEADOW VISTA
Practice Address - State:CA
Practice Address - Zip Code:95722-9531
Practice Address - Country:US
Practice Address - Phone:530-878-2357
Practice Address - Fax:530-878-3910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-28
Last Update Date:2018-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA447711223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty