Provider Demographics
NPI:1982768982
Name:HART, RYAN RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:RICHARD
Last Name:HART
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 1:355 E 50 S
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-3837
Mailing Address - Country:US
Mailing Address - Phone:801-756-0900
Mailing Address - Fax:801-756-7290
Practice Address - Street 1:355 E 50 S
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-3837
Practice Address - Country:US
Practice Address - Phone:801-756-0900
Practice Address - Fax:801-756-7290
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6248077-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist