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General NPI Number Information
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NPI Number | 1194442772
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Entity Type | Organization
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Legal Business Name | NUSET CLARKSVILLE
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Dates
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Enumeration Date | 10/24/2022
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Last Update Date | 10/24/2022
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Provider Practice Location Address
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Address Line | 12431 CLARKSVILLE PIKE ROUTE 108
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City | CLARKSVILLE
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State | MD
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Zip | 21029
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Country | US
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Telephone | 410-531-2265
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Fax |
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Provider Business Mailing Address
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Address Line | 7991 VANCE DR STE A
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City | ARVADA
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State | CO
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Zip | 80003-2148
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Country | US
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Telephone | 303-422-2990
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT CORY RYAN
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Credential | MD/DDS
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Telephone | 303-501-2212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 292200000X
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Taxonomy Name | Dental Laboratory
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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