Provider Demographics
NPI:1427297654
Name:LAWRENCE P. RYAN, DDS, MD, PC
Entity type:Organization
Organization Name:LAWRENCE P. RYAN, DDS, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:P
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:860-295-8780
Mailing Address - Street 1:11 S MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MARLBOROUGH
Mailing Address - State:CT
Mailing Address - Zip Code:06447-1553
Mailing Address - Country:US
Mailing Address - Phone:860-295-8780
Mailing Address - Fax:860-295-0875
Practice Address - Street 1:11 S MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MARLBOROUGH
Practice Address - State:CT
Practice Address - Zip Code:06447-1553
Practice Address - Country:US
Practice Address - Phone:860-295-8780
Practice Address - Fax:860-295-0875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0075291223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT007529OtherCONNECTICARE INSURANCE
PA0418117OtherCIGNA
TN204861OtherCIGNA DENTAL HEALTH
CT020007529CT07OtherANTHEM BLUE CROSS
NJ207529OtherDELTA DENTAL
TX4332423OtherAETNA
CTPENDINGMedicare UPIN