Healthcare Provider Details

I. General information

NPI: 1568073294
Provider Name (Legal Business Name): RYAN JAMES CODY DDS, MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2020
Last Update Date: 12/21/2025
Certification Date: 12/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6624 FANNIN ST STE 1710
HOUSTON TX
77030-2329
US

IV. Provider business mailing address

7575 KIRBY DR APT 2402
HOUSTON TX
77030-4450
US

V. Phone/Fax

Practice location:
  • Phone: 713-489-6984
  • Fax:
Mailing address:
  • Phone: 207-347-0007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number36356
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: