Healthcare Provider Details

I. General information

NPI: 1326542408
Provider Name (Legal Business Name): ROSEMARY RYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2018
Last Update Date: 03/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 DEARFIELD DR
GREENWICH CT
06831-5351
US

IV. Provider business mailing address

34 BOTE RD
GREENWICH CT
06830-4854
US

V. Phone/Fax

Practice location:
  • Phone: 203-869-2044
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number044645-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number8455
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: