Provider Demographics
NPI:1720125321
Name:RYALS, WILLIAM T JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:T
Last Name:RYALS
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10621 BRADDOCK RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-2200
Mailing Address - Country:US
Mailing Address - Phone:703-352-3292
Mailing Address - Fax:703-352-3294
Practice Address - Street 1:10621 BRADDOCK RD
Practice Address - Street 2:SUITE D
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22032-2200
Practice Address - Country:US
Practice Address - Phone:703-352-3292
Practice Address - Fax:703-352-3294
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA04010084461223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics