Provider Demographics
NPI:1740493907
Name:SERRA, RYAN (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:SERRA
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 52ND ST
Mailing Address - Street 2:
Mailing Address - City:HOLMES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34217-1716
Mailing Address - Country:US
Mailing Address - Phone:614-571-5048
Mailing Address - Fax:
Practice Address - Street 1:9126 TOWN CENTER PKWY STE 101
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-5052
Practice Address - Country:US
Practice Address - Phone:941-236-5695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8349122300000X
OH30.0230931223P0300X
FLDN271271223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist