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General NPI Number Information
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NPI Number | 1447832852
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Entity Type | Individual
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Provider Name | RYAN MATTHEW STITT
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Gender | Male
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Dates
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Enumeration Date | 04/25/2021
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Last Update Date | 10/23/2023
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Provider Practice Location Address
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Address Line | 527 TUSKEGEE AIRMEN AVE BLDG 500
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City | SHEPPARD AFB
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State | TX
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Zip | 76311
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Country | US
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Telephone | 940-676-1932
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Fax |
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Provider Business Mailing Address
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Address Line | 9120 NC HIGHWAY 96 NORTH
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City | OXFORD
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State | NC
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Zip | 27565
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Country | US
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Telephone | 919-886-1846
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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 | 26283
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License Number State | FL
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