Healthcare Provider Details

I. General information

NPI: 1174853394
Provider Name (Legal Business Name): AMBER MARIE RYAN RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2010
Last Update Date: 01/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VILSECK DENTAL CLINIC UNIT 28038
APO AE
09112
US

IV. Provider business mailing address

CMR 411 BOX 2734
APO AE
09112-0028
US

V. Phone/Fax

Practice location:
  • Phone: 966-283-1720
  • Fax:
Mailing address:
  • Phone: 96626699581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number10478
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: