Healthcare Provider Details

I. General information

NPI: 1003093469
Provider Name (Legal Business Name): TERRENCE WAYNE RYCKMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 N PARK ST
OWOSSO MI
48867-3044
US

IV. Provider business mailing address

310 N PARK ST
OWOSSO MI
48867-3044
US

V. Phone/Fax

Practice location:
  • Phone: 989-723-8440
  • Fax:
Mailing address:
  • Phone: 989-723-8440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901009648
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: