Provider Demographics
NPI:1194935759
Name:RYAN, BERNARD EUGENE II (DDS)
Entity type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:EUGENE
Last Name:RYAN
Suffix:II
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 1:9 BRIARCLIFF PROFESSIONAL CENTER
Mailing Address - Street 2:SUITE D
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-2429
Mailing Address - Country:US
Mailing Address - Phone:815-932-9695
Mailing Address - Fax:815-929-0582
Practice Address - Street 1:9 BRIARCLIFF PROFESSIONAL CENTER
Practice Address - Street 2:SUITE D
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-2429
Practice Address - Country:US
Practice Address - Phone:815-932-9695
Practice Address - Fax:815-929-0582
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist