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General NPI Number Information
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NPI Number | 1619350576
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Entity Type | Individual
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Provider Name | RYAN ILG REICHELT D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/09/2015
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 950 S TAMIAMI TRL STE 205
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City | SARASOTA
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State | FL
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Zip | 34236-7818
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Country | US
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Telephone | 631-742-1877
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Fax |
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Provider Business Mailing Address
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Address Line | 8 TULIP DR
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City | LLOYD HARBOR
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State | NY
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Zip | 11743-9761
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Country | US
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Telephone | 631-742-1877
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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 | DN1858185
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN1858185
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License Number State | MA
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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 | 11910
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 058692
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License Number State | NY
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Taxonomy #5
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN25160
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License Number State | FL
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