Healthcare Provider Details

I. General information

NPI: 1891365052
Provider Name (Legal Business Name): RYAN STERK INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 CARLISLE BLVD NE
ALBUQUERQUE NM
87110-5685
US

IV. Provider business mailing address

1513 CARLISLE BLVD NE
ALBUQUERQUE NM
87110-5685
US

V. Phone/Fax

Practice location:
  • Phone: 505-881-7373
  • Fax: 505-881-5096
Mailing address:
  • Phone: 505-881-7373
  • Fax: 505-881-5096

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. RYAN TODD STERK
Title or Position: CEO
Credential: DDS
Phone: 505-459-1245