1588854152 NPI number — DR. RYAN CURTIS PENDLETON D.D.S.

Table of content: DR. RYAN CURTIS PENDLETON D.D.S. (NPI 1588854152)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588854152 NPI number — DR. RYAN CURTIS PENDLETON D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PENDLETON
Provider First Name:
RYAN
Provider Middle Name:
CURTIS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
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:
1588854152
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/13/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1840 CRYSTAL FALLS PARKWAY
Provider Second Line Business Mailing Address:
SUITE #420
Provider Business Mailing Address City Name:
LEANDER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78641-4108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-355-7727
Provider Business Mailing Address Fax Number:
512-355-7729

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18433 ROSCOE BLVD
Provider Second Line Business Practice Location Address:
SUITE #201
Provider Business Practice Location Address City Name:
NORTHRIDGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91325-4108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-882-0100
Provider Business Practice Location Address Fax Number:
818-882-0101
Provider Enumeration Date:
07/30/2007

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: 1223X0400X , with the licence number:  31552 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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