Provider Demographics
NPI:1831391507
Name:THOMAS, RYAN E (DDS)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:E
Last Name:THOMAS
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 1:9151 RED ARROW HWY
Mailing Address - Street 2:
Mailing Address - City:BRIDGMAN
Mailing Address - State:MI
Mailing Address - Zip Code:49106-9558
Mailing Address - Country:US
Mailing Address - Phone:269-465-5151
Mailing Address - Fax:269-465-3836
Practice Address - Street 1:9151 RED ARROW HWY
Practice Address - Street 2:
Practice Address - City:BRIDGMAN
Practice Address - State:MI
Practice Address - Zip Code:49106-9558
Practice Address - Country:US
Practice Address - Phone:269-465-5151
Practice Address - Fax:269-465-3836
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019616122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist