Provider Demographics
NPI:1285948356
Name:RYNN, MICHELLE HOWARD (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:HOWARD
Last Name:RYNN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 S 5TH AVE
Mailing Address - Street 2:EDWARD HINES JR. VA HOSPITAL DENTAL SERVICE
Mailing Address - City:HINES
Mailing Address - State:IL
Mailing Address - Zip Code:60141-3030
Mailing Address - Country:US
Mailing Address - Phone:708-202-8387
Mailing Address - Fax:708-202-7165
Practice Address - Street 1:5000 S 5TH AVE
Practice Address - Street 2:EDWARD HINES JR. VA HOSPITAL DENTAL SERVICE
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141-3030
Practice Address - Country:US
Practice Address - Phone:708-202-8387
Practice Address - Fax:708-202-7165
Is Sole Proprietor?:No
Enumeration Date:2010-08-01
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190283701223P0700X
CODEN.00202730122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist