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General NPI Number Information
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NPI Number | 1841334760
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Entity Type | Individual
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Provider Name | WILLIAM RYAN BAGLEY DDS
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Gender | Male
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 4904 CONVENTION DR
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City | PASCO
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State | WA
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Zip | 99301
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Country | US
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Telephone | 509-547-1631
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Fax | 509-547-3885
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Provider Business Mailing Address
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Address Line | 202 PIPER ST
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City | RICHLAND
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State | WA
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Zip | 99352-8702
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Country | US
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Telephone | 509-628-8999
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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 | DE009032
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License Number State | WA
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