Provider Demographics
NPI:1982792933
Name:REDFEARN, RYAN MERRILL (DDS)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:MERRILL
Last Name:REDFEARN
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 1:8063 S WILLIAMS CT
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-3246
Mailing Address - Country:US
Mailing Address - Phone:720-283-7071
Mailing Address - Fax:
Practice Address - Street 1:3601 S CLARKSON ST STE 315
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3947
Practice Address - Country:US
Practice Address - Phone:303-762-8046
Practice Address - Fax:303-762-8047
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO89521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice