Healthcare Provider Details

I. General information

NPI: 1578915906
Provider Name (Legal Business Name): RYAN HAIG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2016
Last Update Date: 07/21/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 RESNIK RD
PLYMOUTH MA
02360-7211
US

IV. Provider business mailing address

30 RESNIK RD
PLYMOUTH MA
02360-7211
US

V. Phone/Fax

Practice location:
  • Phone: 508-746-8700
  • Fax:
Mailing address:
  • Phone: 508-746-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0401415307
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number61946
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number61946
License Number StateKS
# 4
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1469118
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: