Provider Demographics
NPI:1811071855
Name:MCCAFFERTY, RYAN JOHN (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:JOHN
Last Name:MCCAFFERTY
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:555 LAKEHURST RD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-8044
Mailing Address - Country:US
Mailing Address - Phone:732-341-6800
Mailing Address - Fax:732-341-2112
Practice Address - Street 1:555 LAKEHURST RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8044
Practice Address - Country:US
Practice Address - Phone:732-341-6800
Practice Address - Fax:732-341-2112
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DIO18017001223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics