Provider Demographics
NPI:1801991674
Name:WORKMAN, RYAN MATTHEW (DDS)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:MATTHEW
Last Name:WORKMAN
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 1:11025 S CAROLINE GROVE LN
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-1218
Mailing Address - Country:US
Mailing Address - Phone:801-674-9584
Mailing Address - Fax:
Practice Address - Street 1:2301 MOUNTAIN VIEW BLVD
Practice Address - Street 2:
Practice Address - City:WOODS CROSS
Practice Address - State:UT
Practice Address - Zip Code:84087-2442
Practice Address - Country:US
Practice Address - Phone:801-674-9584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT49426609922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist