Provider Demographics
NPI:1588071823
Name:COURSEY, RYAN (DMD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:COURSEY
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 1:7891 E 108TH ST
Mailing Address - Street 2:SUITE X-4
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-7405
Mailing Address - Country:US
Mailing Address - Phone:918-849-7548
Mailing Address - Fax:
Practice Address - Street 1:7891 E 108TH ST
Practice Address - Street 2:SUITE X-4
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-7405
Practice Address - Country:US
Practice Address - Phone:918-849-7548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-18
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6565122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist