MEDICARE: DR. RYAN M TENNANT DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DE10286	WA

General Provider Information

NPI Number	:	1225083553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN M TENNANT DDS

Provider Business Mailing Address
First Line	:	3257 26TH AVE W
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98199-2823
Country	:	US
Telephone Number	:	206-240-6415
Fax Number	:	206-352-3962

Provider Business Practice Location Address
First Line	:	200 W MERCER ST
Second Line	:	STE. 205
City	:	SEATTLE
State	:	WA
Zip	:	98119-3995
Country	:	US
Telephone Number	:	206-281-8300
Fax Number	:	206-281-0075

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	07/08/2007

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