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General NPI Number Information
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NPI Number | 1356623995
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Entity Type | Individual
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Provider Name | RYAN JAMES CANADA D.M.D
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Gender | Male
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Dates
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Enumeration Date | 09/09/2011
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Last Update Date | 04/11/2019
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Provider Practice Location Address
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Address Line | 3500 S LAKEPORT ST
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City | SIOUX CITY
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State | IA
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Zip | 51106-4516
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Country | US
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Telephone | 712-276-5547
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Fax |
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Provider Business Mailing Address
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Address Line | 3050 VALLEY DR
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City | SIOUX CITY
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State | IA
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Zip | 51104-4074
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Country | US
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Telephone |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 6109
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6998
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 09501
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License Number State | IA
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