Provider Demographics
NPI:1902467475
Name:COON, RYAN JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:JOHN
Last Name:COON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-4419
Mailing Address - Country:US
Mailing Address - Phone:515-210-8025
Mailing Address - Fax:
Practice Address - Street 1:3906 STATE ST STE 103
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-3114
Practice Address - Country:US
Practice Address - Phone:805-687-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX352081223G0001X
CA1103121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice