Provider Demographics
NPI:1740377480
Name:ROBERT J RYAN DDS PC
Entity type:Organization
Organization Name:ROBERT J RYAN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-506-1144
Mailing Address - Street 1:601 W CENTRAL RD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056
Mailing Address - Country:US
Mailing Address - Phone:847-506-1144
Mailing Address - Fax:847-506-1149
Practice Address - Street 1:601 W CENTRAL RD
Practice Address - Street 2:SUITE 9
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056
Practice Address - Country:US
Practice Address - Phone:847-506-1144
Practice Address - Fax:847-506-1149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2159651223P0300X
IL19A151561223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty