Healthcare Provider Details

I. General information

NPI: 1720311442
Provider Name (Legal Business Name): RYAN DAVID WOMACK M.D., D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2008 CATON WAY SW STE 101
OLYMPIA WA
98502-2100
US

IV. Provider business mailing address

2008 CATON WAY SW STE 101
OLYMPIA WA
98502-2100
US

V. Phone/Fax

Practice location:
  • Phone: 360-754-9444
  • Fax: 360-754-8335
Mailing address:
  • Phone: 360-754-9444
  • Fax: 360-754-8335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberMD.602817188
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberM6467
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDE.60280647
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: