Healthcare Provider Details

I. General information

NPI: 1750673562
Provider Name (Legal Business Name): RYAN MIKHAIL DAVID CALVI D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 BERKSHIRE BLVD
WYOMISSING PA
19610-1264
US

IV. Provider business mailing address

1075 BERKSHIRE BLVD STE 800
WYOMISSING PA
19610-1264
US

V. Phone/Fax

Practice location:
  • Phone: 610-374-4093
  • Fax:
Mailing address:
  • Phone: 610-374-4093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS038714
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS038714
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number016.0116639
License Number StateVT
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberG3-0000381
License Number StateDE
# 5
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDS038714
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: