Healthcare Provider Details

I. General information

NPI: 1497188320
Provider Name (Legal Business Name): WILLIAM P. RYAN, DMD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2013
Last Update Date: 08/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 HINSDALE AVE
WINSTED CT
06098-1133
US

IV. Provider business mailing address

10 HINSDALE AVE
WINSTED CT
06098-1133
US

V. Phone/Fax

Practice location:
  • Phone: 860-379-4382
  • Fax: 860-738-4720
Mailing address:
  • Phone: 860-379-4382
  • Fax: 860-738-4720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM P RYAN
Title or Position: OWNER/DENTIST
Credential: DMD
Phone: 860-379-4382