Healthcare Provider Details

I. General information

NPI: 1225114630
Provider Name (Legal Business Name): RODERICK RYAN DOWDEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9623 WINDERMERE BLVD STE A
FISHERS IN
46037
US

IV. Provider business mailing address

9623 WINDERMERE BLVD STE A
FISHERS IN
46037
US

V. Phone/Fax

Practice location:
  • Phone: 317-594-0461
  • Fax: 317-594-0477
Mailing address:
  • Phone: 317-594-0461
  • Fax: 317-594-0477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12009659
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: