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General NPI Number Information
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NPI Number | 1740322049
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Entity Type | Individual
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Provider Name | MARK T RYAN DMD
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Gender | Male
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 622 SAVIN AVENUE
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City | WEST HAVEN
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State | CT
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Zip | 06516-4936
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Country | US
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Telephone | 203-933-7095
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Fax | 203-937-5766
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Provider Business Mailing Address
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Address Line | 622 SAVIN AVENUE
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City | WEST HAVEN
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State | CT
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Zip | 06516-4936
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Country | US
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Telephone | 203-933-7095
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Fax | 203-937-5766
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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 | 008359
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 05006
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 005913
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License Number State | CT
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