Healthcare Provider Details

I. General information

NPI: 1235347303
Provider Name (Legal Business Name): HARRY L. RYBURN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 S MULBERRY ST SUITE A
PINE BLUFF AR
71603-7017
US

IV. Provider business mailing address

6 HILLCROFT ST
PINE BLUFF AR
71603-7312
US

V. Phone/Fax

Practice location:
  • Phone: 870-535-5616
  • Fax:
Mailing address:
  • Phone: 870-534-8231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberPERS.1682- CORP.291
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: