Provider Demographics
NPI:1952995979
Name:MARDER, RYAN EDWARD (DDS)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:EDWARD
Last Name:MARDER
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 1:2010 RESERVE LN
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-6212
Mailing Address - Country:US
Mailing Address - Phone:704-574-2151
Mailing Address - Fax:
Practice Address - Street 1:1325 BRADFORD VIEW DR STE 120
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-9232
Practice Address - Country:US
Practice Address - Phone:984-465-1110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-22
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC127031223G0001X
NC390200000X
SC9882122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No122300000XDental ProvidersDentist