Provider Demographics
NPI:1780738773
Name:RYAN, RICHARD J (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:RYAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SOUTH 631 ROUTE 59
Mailing Address - Street 2:SUITE D
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-1440
Mailing Address - Country:US
Mailing Address - Phone:630-393-2733
Mailing Address - Fax:630-836-1198
Practice Address - Street 1:2 SOUTH 631 ROUTE 59
Practice Address - Street 2:SUITE D
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-1440
Practice Address - Country:US
Practice Address - Phone:630-393-2733
Practice Address - Fax:630-836-1198
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-015908122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36-2940514OtherFEIN