Healthcare Provider Details

I. General information

NPI: 1073824231
Provider Name (Legal Business Name): RYAN P GEBFERT DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 06/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10010 DUPONT CIRCLE CT
FORT WAYNE IN
46825-1626
US

IV. Provider business mailing address

10010 DUPONT CIRCLE COURT
FORT WAYNE IN
46845
US

V. Phone/Fax

Practice location:
  • Phone: 260-490-4440
  • Fax:
Mailing address:
  • Phone: 260-490-4440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12011487A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: