Healthcare Provider Details

I. General information

NPI: 1669614137
Provider Name (Legal Business Name): RYAN JAMES LANMAN D.D.S. M.S.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2009
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 # I
OKLAHOMA CITY OK
73116-2041
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number6272
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: