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General NPI Number Information
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NPI Number | 1033296603
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Entity Type | Individual
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Provider Name | DALLAS RYAN DDS
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Gender | Male
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4001 HIGHWAY 36 S
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City | BRENHAM
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State | TX
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Zip | 77833-9610
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Country | US
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Telephone | 979-277-1346
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1660
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City | FRIENDSWOOD
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State | TX
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Zip | 77549-1660
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Country | US
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Telephone | 281-923-8843
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 12492
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License Number State | TX
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