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General NPI Number Information
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NPI Number | 1457629198
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Entity Type | Organization
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Legal Business Name | RYAN A DRAISS DMD LLC
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Dates
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Enumeration Date | 12/08/2011
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Last Update Date | 12/08/2011
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Provider Practice Location Address
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Address Line | 407 CHELSEA CROSSROADS
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City | CHELSEA
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State | AL
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Zip | 35043-3901
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Country | US
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Telephone | 205-370-7499
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Fax |
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Provider Business Mailing Address
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Address Line | 407 CHELSEA CROSSROADS
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City | CHELSEA
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State | AL
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Zip | 35043-3901
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Country | US
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Telephone | 205-370-7499
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RYAN A DRAISS
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Credential | DMD
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Telephone | 205-370-7499
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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 | 5781
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License Number State | AL
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