1780738773 NPI number — DR. RICHARD J RYAN D.D.S.

Table of content: DR. RICHARD J RYAN D.D.S. (NPI 1780738773)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780738773 NPI number — DR. RICHARD J RYAN D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RYAN
Provider First Name:
RICHARD
Provider Middle Name:
J
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:
1780738773
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 SOUTH 631 ROUTE 59
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
WARRENVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60555-1440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-393-2733
Provider Business Mailing Address Fax Number:
630-836-1198

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 SOUTH 631 ROUTE 59
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
WARRENVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60555-1440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-393-2733
Provider Business Practice Location Address Fax Number:
630-836-1198
Provider Enumeration Date:
01/23/2007

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: 122300000X , with the licence number:  019-015908 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 36-2940514 . This is a "FEIN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com