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NPI Code Detail

MEDICARE: DR. RYAN DOUGLAS BLISSETT D.M.D.

MEDICARE: DR. RYAN DOUGLAS BLISSETT D.M.D.
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
11223P0700XProsthodontics21630MA

General Provider Information

NPI Number : 1972690691
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RYAN DOUGLAS BLISSETT D.M.D.
Provider Business Mailing Address
First Line : 1540 BEACON ST
Second Line :
City : BROOKLINE
State : MA
Zip : 02446-2215
Country : US
Telephone Number : 617-738-1950
Fax Number :
Provider Business Practice Location Address
First Line : 1540 BEACON ST
Second Line :
City : BROOKLINE
State : MA
Zip : 02446-2215
Country : US
Telephone Number : 617-738-1950
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2006
Last Update Date : 05/31/2009

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