Provider Demographics
NPI:1801158985
Name:RYAN, DAVID C (DMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:RYAN
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 1:7895 CULEBRA RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-1441
Mailing Address - Country:US
Mailing Address - Phone:210-686-0539
Mailing Address - Fax:
Practice Address - Street 1:7895 CULEBRA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-1441
Practice Address - Country:US
Practice Address - Phone:210-686-0539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2021-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00204443122300000X
AZD0084531223G0001X
TX372181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist