MEDICARE: DR. JERON RYAN PC

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	261QD0000X	Dental Clinic/Center	12037	MD

General Provider Information

NPI Number	:	1811017874
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. JERON RYAN PC

Provider Business Mailing Address
First Line	:	3311 TOLEDO TER
Second Line	:	SUITE C-102
City	:	HYATTSVILLE
State	:	MD
Zip	:	20782-4135
Country	:	US
Telephone Number	:	301-559-3668
Fax Number	:	301-559-0670

Provider Business Practice Location Address
First Line	:	3311 TOLEDO TER
Second Line	:	SUITE C-102
City	:	HYATTSVILLE
State	:	MD
Zip	:	20782-4135
Country	:	US
Telephone Number	:	301-559-3668
Fax Number	:	301-559-0670

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JERON SKERRITT-RYAN
Credential	:
Telephone Number	:	301-559-3668

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	03/01/2010

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