Healthcare Provider Details

I. General information

NPI: 1891920351
Provider Name (Legal Business Name): MICHAEL S RYCKMAN DMD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 05/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 SHROYER RD
DAYTON OH
45419-3635
US

IV. Provider business mailing address

1007 SHROYER RD
DAYTON OH
45419-3635
US

V. Phone/Fax

Practice location:
  • Phone: 937-294-1001
  • Fax: 937-294-0798
Mailing address:
  • Phone: 937-294-1001
  • Fax: 937-294-0798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number30-022720
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: