MEDICARE: DR. RICHARD G RYAN 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	122300000X	Dentist	23472	NY

General Provider Information

NPI Number	:	1659472835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD G RYAN DDS

Provider Business Mailing Address
First Line	:	2000 MAPLE HILL ST
Second Line	:
City	:	YORKTOWN HTS
State	:	NY
Zip	:	10598
Country	:	US
Telephone Number	:	914-912-7004
Fax Number	:	914-912-7005

Provider Business Practice Location Address
First Line	:	2000 MAPLE HILL ST
Second Line	:
City	:	YORKTOWN HTS
State	:	NY
Zip	:	10598
Country	:	US
Telephone Number	:	914-912-7004
Fax Number	:	914-912-7005

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

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	07/08/2007

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