Provider Demographics
NPI:1316424377
Name:WHELEN, RYAN JOHN (DMD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:JOHN
Last Name:WHELEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 BALD EAGLE DR.
Mailing Address - Street 2:STE.200
Mailing Address - City:200
Mailing Address - State:FL
Mailing Address - Zip Code:34145
Mailing Address - Country:US
Mailing Address - Phone:239-394-1004
Mailing Address - Fax:239-330-1487
Practice Address - Street 1:606 BALD EAGLE DR.
Practice Address - Street 2:STE.200
Practice Address - City:200
Practice Address - State:FL
Practice Address - Zip Code:34145
Practice Address - Country:US
Practice Address - Phone:239-394-1004
Practice Address - Fax:239-330-1487
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.025542122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist