Provider Demographics
NPI:1407193659
Name:STOOPS, RYAN C
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:C
Last Name:STOOPS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 AUBURN CT STE 6
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-3692
Mailing Address - Country:US
Mailing Address - Phone:805-495-4601
Mailing Address - Fax:805-495-0861
Practice Address - Street 1:176 AUBURN CT STE 6
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-3692
Practice Address - Country:US
Practice Address - Phone:805-495-4601
Practice Address - Fax:805-495-0861
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA466931223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics