Healthcare Provider Details

I. General information

NPI: 1225231996
Provider Name (Legal Business Name): RYAN DANIEL ESCUDERO D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3532 HOWARD AVE STE 100
LOS ALAMITOS CA
90720-3681
US

IV. Provider business mailing address

3532 HOWARD AVE STE 100
LOS ALAMITOS CA
90720-3681
US

V. Phone/Fax

Practice location:
  • Phone: 562-795-7777
  • Fax:
Mailing address:
  • Phone: 562-795-7777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0524411
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22276
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number59256
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: