Healthcare Provider Details

I. General information

NPI: 1568895977
Provider Name (Legal Business Name): KEVIN WILLIAM RYAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2013
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 MISSION AVE STE 4
OCEANSIDE CA
92058-7129
US

IV. Provider business mailing address

1000 VALE TERRACE DR
VISTA CA
92084-5218
US

V. Phone/Fax

Practice location:
  • Phone: 760-631-5000
  • Fax: 760-414-3885
Mailing address:
  • Phone: 760-631-5000
  • Fax: 760-414-3885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS102063
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: