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General NPI Number Information
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NPI Number | 1013189349
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Entity Type | Organization
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Legal Business Name | WEST RIDGE FAMILY DENTAL, P.C.
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Dates
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Enumeration Date | 03/26/2008
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Last Update Date | 03/26/2008
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Provider Practice Location Address
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Address Line | 5712 W RIDGE RD
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City | ERIE
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State | PA
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Zip | 16506-1014
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Country | US
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Telephone | 814-833-1131
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Fax |
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Provider Business Mailing Address
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Address Line | 5712 W RIDGE RD
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City | ERIE
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State | PA
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Zip | 16506-1014
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Country | US
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Telephone | 814-833-1131
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | DR. RYAN D BLANC
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Credential | DDS
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Telephone | 814-833-1131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS036140
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License Number State | PA
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