Healthcare Provider Details

I. General information

NPI: 1033810098
Provider Name (Legal Business Name): RYAN, JAMES, WILES, PATEL & OLSEN LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2409 ROBESON ST
FAYETTEVILLE NC
28305-5549
US

IV. Provider business mailing address

2028 LITHO PL STE 300
FAYETTEVILLE NC
28304-2538
US

V. Phone/Fax

Practice location:
  • Phone: 910-483-9546
  • Fax:
Mailing address:
  • Phone: 910-485-7070
  • Fax: 910-485-1151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. VIRGINIA JONES
Title or Position: CEO
Credential: PHD
Phone: 910-485-7070