Provider Demographics
NPI:1932454030
Name:RYAN D WOMACK MD DDS PLLC
Entity Type:Organization
Organization Name:RYAN D WOMACK MD DDS PLLC
Other - Org Name:CAPITAL ORAL & MAXILLOFACIAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WOMACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DDS
Authorized Official - Phone:360-754-9444
Mailing Address - Street 1:400 YAUGER WAY SW
Mailing Address - Street 2:SUITE A
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-8139
Mailing Address - Country:US
Mailing Address - Phone:360-754-9444
Mailing Address - Fax:360-754-8335
Practice Address - Street 1:400 YAUGER WAY SW
Practice Address - Street 2:SUITE A
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8139
Practice Address - Country:US
Practice Address - Phone:360-754-9444
Practice Address - Fax:360-754-8335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE.60280647261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery