Healthcare Provider Details

I. General information

NPI: 1023173093
Provider Name (Legal Business Name): JAMES E RYAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 S THIRD ST
ROGERS CITY MI
49779
US

IV. Provider business mailing address

216 S THIRD ST
ROGERS CITY MI
49779
US

V. Phone/Fax

Practice location:
  • Phone: 989-734-2828
  • Fax: 989-734-8036
Mailing address:
  • Phone: 989-734-2828
  • Fax: 989-734-8036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9960
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: