Healthcare Provider Details

I. General information

NPI: 1114668522
Provider Name (Legal Business Name): SAMANTHA GALLIA RYAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7916 PEBBLE BEACH DR
CITRUS HEIGHTS CA
95610-7790
US

IV. Provider business mailing address

5033 T ST
SACRAMENTO CA
95819-4834
US

V. Phone/Fax

Practice location:
  • Phone: 916-962-0477
  • Fax:
Mailing address:
  • Phone: 916-747-4512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number111716
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: