Provider Demographics
NPI:1801121439
Name:KEYES, RYAN ALLEN (BDENT)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:ALLEN
Last Name:KEYES
Suffix:
Gender:M
Credentials:BDENT
Other - Prefix:
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Mailing Address - Street 1:515 DELAWARE ST SE
Mailing Address - Street 2:9-176 MOOS HEALTH SCIENCE TOWER
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0357
Mailing Address - Country:US
Mailing Address - Phone:612-625-5655
Mailing Address - Fax:612-626-2655
Practice Address - Street 1:515 DELAWARE ST SE
Practice Address - Street 2:9-176 MOOS HEALTH SCIENCE TOWER
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0357
Practice Address - Country:US
Practice Address - Phone:612-625-5655
Practice Address - Fax:612-626-2655
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR4621223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics