Provider Demographics
NPI:1881255495
Name:RYAN BREASBOIS DDS PC
Entity type:Organization
Organization Name:RYAN BREASBOIS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BREASBOIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-546-9190
Mailing Address - Street 1:1455 N MICHIGAN AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-3103
Mailing Address - Country:US
Mailing Address - Phone:517-546-9190
Mailing Address - Fax:517-546-9690
Practice Address - Street 1:1455 N MICHIGAN AVE STE 500
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-3103
Practice Address - Country:US
Practice Address - Phone:517-546-9190
Practice Address - Fax:517-546-9690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental