Healthcare Provider Details

I. General information

NPI: 1952074130
Provider Name (Legal Business Name): GEORGE RYAN SLOAN DDS, MDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2021
Last Update Date: 07/26/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 LAKESIDE DR
RENO NV
89509-3464
US

IV. Provider business mailing address

8263 GRAYCE DR
SOUTHAVEN MS
38671-7052
US

V. Phone/Fax

Practice location:
  • Phone: 775-323-3574
  • Fax:
Mailing address:
  • Phone: 505-414-2889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number7476
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: