Provider Demographics
NPI:1700969706
Name:RYAN, JENNIFER LEE (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LEE
Last Name:RYAN
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Gender:F
Credentials:DDS, MS
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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:530-878-8089
Practice Address - Street 1:2545 E BIDWELL ST STE 100
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-6443
Practice Address - Country:US
Practice Address - Phone:916-984-6200
Practice Address - Fax:916-235-7469
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2009-10-14
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Provider Licenses
StateLicense IDTaxonomies
CA447711223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry