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General NPI Number Information
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NPI Number | 1437104080
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Entity Type | Organization
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Legal Business Name | DR MICHAEL RYAN PC
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 30 MEDICAL CENTER BLVD SUITE 100
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City | UPLAND
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State | PA
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Zip | 19013-3955
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Country | US
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Telephone | 610-872-1355
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Fax | 610-874-2587
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Provider Business Mailing Address
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Address Line | 30 MEDICAL CENTER BLVD SUITE 100
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City | UPLAND
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State | PA
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Zip | 19013-3955
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Country | US
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Telephone | 610-872-1355
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Fax | 610-874-2587
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL D RYAN
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Credential | DDS
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Telephone | 610-872-1355
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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 | DS016527L
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License Number State | PA
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