Provider Demographics
NPI:1982707568
Name:CANDELORA, RYAN K (DDS)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:K
Last Name:CANDELORA
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 1:500 N CENTRAL AVE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-3905
Mailing Address - Country:US
Mailing Address - Phone:818-240-7040
Mailing Address - Fax:
Practice Address - Street 1:500 N CENTRAL AVE
Practice Address - Street 2:SUITE 700
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-3905
Practice Address - Country:US
Practice Address - Phone:818-240-7040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51047122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist