Provider Demographics
NPI:1528127719
Name:JOUETT, RYAN MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:MICHAEL
Last Name:JOUETT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1615 BARAK LN
Mailing Address - Street 2:STE. 5
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-3315
Mailing Address - Country:US
Mailing Address - Phone:979-846-1121
Mailing Address - Fax:979-846-5771
Practice Address - Street 1:1615 BARAK LN
Practice Address - Street 2:STE. 5
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3315
Practice Address - Country:US
Practice Address - Phone:979-846-1121
Practice Address - Fax:979-846-5771
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD226231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice