Healthcare Provider Details

I. General information

NPI: 1699482976
Provider Name (Legal Business Name): RYAN P. NEBEL, D.M.D. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2022
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 WILMINGTON RD
NEW CASTLE PA
16105-1131
US

IV. Provider business mailing address

3105 WILMINGTON RD
NEW CASTLE PA
16105-1131
US

V. Phone/Fax

Practice location:
  • Phone: 724-654-2330
  • Fax: 724-658-3719
Mailing address:
  • Phone: 724-654-2330
  • Fax: 724-658-3719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: RYAN PATRICK NEBEL
Title or Position: OWNER
Credential: DMD
Phone: 724-654-2330