1861682783 NPI number — DR. JEFFREY LLOYD RYAN DDS MS

Table of content: DR. JEFFREY LLOYD RYAN DDS MS (NPI 1861682783)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861682783 NPI number — DR. JEFFREY LLOYD RYAN DDS MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RYAN
Provider First Name:
JEFFREY
Provider Middle Name:
LLOYD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS MS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861682783
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1900 KRUTCHEN COURT SOUTH
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
SARTELL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56377
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-656-1456
Provider Business Mailing Address Fax Number:
320-656-0195

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 KRUTCHEN COURT SOUTH
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SARTELL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56377
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-656-1456
Provider Business Practice Location Address Fax Number:
320-656-0195
Provider Enumeration Date:
07/26/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223E0200X , with the licence number:  11790 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)