Healthcare Provider Details

I. General information

NPI: 1730892290
Provider Name (Legal Business Name): RYAN J LANMAN, DDS, MSD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2022
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3621 NW 63RD ST STE I
OKLAHOMA CITY OK
73116-2041
US

IV. Provider business mailing address

3621 NW 63RD ST STE I
OKLAHOMA CITY OK
73116-2041
US

V. Phone/Fax

Practice location:
  • Phone: 405-840-2834
  • Fax: 405-848-9332
Mailing address:
  • Phone: 405-840-2834
  • Fax: 405-848-9332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RYAN J LANMAN
Title or Position: OWNER
Credential: DDS
Phone: 405-840-2834