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General NPI Number Information
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NPI Number | 1710141213
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Entity Type | Individual
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Provider Name | MARIA EMANUEL RYAN DDS, PHD
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Gender | Female
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Dates
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Enumeration Date | 07/14/2008
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Last Update Date | 07/14/2008
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Provider Practice Location Address
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Address Line | STONY BROOK UNIVERSITY SDM WESTCHESTER HALL, DEPT OF OB&P
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City | STONY BROOK
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State | NY
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Zip | 11794-0001
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Country | US
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Telephone | 631-632-9529
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Fax | 631-932-9705
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Provider Business Mailing Address
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Address Line | 1302 RIDGE ROAD
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City | LAUREL HOLLOW
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State | NY
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Zip | 11791
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Country | US
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Telephone | 516-692-4379
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 0448091
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License Number State | NY
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