Provider Demographics
NPI:1962771659
Name:RYAN DENTAL GROUP
Entity type:Organization
Organization Name:RYAN DENTAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARPIT
Authorized Official - Middle Name:
Authorized Official - Last Name:MODY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-506-3534
Mailing Address - Street 1:26620 RYAN RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48091-1144
Mailing Address - Country:US
Mailing Address - Phone:586-755-4770
Mailing Address - Fax:
Practice Address - Street 1:26620 RYAN RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48091-1144
Practice Address - Country:US
Practice Address - Phone:586-755-4770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-24
Last Update Date:2011-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010178461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty