Provider Demographics
NPI:1780992040
Name:YAKOWICZ, RYAN JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:JOHN
Last Name:YAKOWICZ
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 1:120 GREENWAY CROSS CT
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53508-8800
Mailing Address - Country:US
Mailing Address - Phone:608-424-3222
Mailing Address - Fax:
Practice Address - Street 1:120 GREENWAY CROSS CT
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53508-8800
Practice Address - Country:US
Practice Address - Phone:608-424-3222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6606-151223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral Practice