Healthcare Provider Details

I. General information

NPI: 1275465957
Provider Name (Legal Business Name): RYAN CHRISTOPHER CORNWALL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 HENRY CHAPPLE ST
BILLINGS MT
59106-1858
US

IV. Provider business mailing address

1113 VICTORY AVE
BILLINGS MT
59105-1856
US

V. Phone/Fax

Practice location:
  • Phone: 406-652-1600
  • Fax:
Mailing address:
  • Phone: 406-850-1682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN-DEN-LIC-33334
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: