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General NPI Number Information
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NPI Number | 1427297654
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Entity Type | Organization
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Legal Business Name | LAWRENCE P. RYAN, DDS, MD, PC
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Dates
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Enumeration Date | 02/11/2009
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Last Update Date | 02/11/2009
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Provider Practice Location Address
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Address Line | 11 S MAIN ST SUITE 1
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City | MARLBOROUGH
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State | CT
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Zip | 06447-1553
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Country | US
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Telephone | 860-295-8780
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Fax | 860-295-0875
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Provider Business Mailing Address
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Address Line | 11 S MAIN ST SUITE 1
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City | MARLBOROUGH
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State | CT
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Zip | 06447-1553
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Country | US
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Telephone | 860-295-8780
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Fax | 860-295-0875
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Authorized Official
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Title or Position | OWNER
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Name | DR. LAWRENCE P RYAN
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Credential | DDS, MD
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Telephone | 860-295-8780
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 007529
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License Number State | CT
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