Provider Demographics
NPI:1750673562
Name:CALVI, RYAN MIKHAIL DAVID (DMD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:MIKHAIL DAVID
Last Name:CALVI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 BERKSHIRE BLVD STE 800
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1264
Mailing Address - Country:US
Mailing Address - Phone:610-374-4093
Mailing Address - Fax:
Practice Address - Street 1:1075 BERKSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1264
Practice Address - Country:US
Practice Address - Phone:610-374-4093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS038714122300000X, 1223S0112X, 204E00000X
VT016.01166391223S0112X
DEG3-0000381390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No122300000XDental ProvidersDentist
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program