Provider Demographics
NPI:1497188320
Name:WILLIAM P. RYAN, DMD, LLC
Entity type:Organization
Organization Name:WILLIAM P. RYAN, DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:P
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-379-4382
Mailing Address - Street 1:10 HINSDALE AVE
Mailing Address - Street 2:
Mailing Address - City:WINSTED
Mailing Address - State:CT
Mailing Address - Zip Code:06098-1133
Mailing Address - Country:US
Mailing Address - Phone:860-379-4382
Mailing Address - Fax:860-738-4720
Practice Address - Street 1:10 HINSDALE AVE
Practice Address - Street 2:
Practice Address - City:WINSTED
Practice Address - State:CT
Practice Address - Zip Code:06098-1133
Practice Address - Country:US
Practice Address - Phone:860-379-4382
Practice Address - Fax:860-738-4720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No126800000XDental ProvidersDental AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1548354012Medicaid