Healthcare Provider Details

I. General information

NPI: 1538853171
Provider Name (Legal Business Name): RYAN JAMES MOYLAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 BLAIRS FERRY RD
HIAWATHA IA
52233-2033
US

IV. Provider business mailing address

1700 BLAIRS FERRY RD
HIAWATHA IA
52233-2033
US

V. Phone/Fax

Practice location:
  • Phone: 319-396-3596
  • Fax:
Mailing address:
  • Phone: 319-396-3596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS-10100
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: