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General NPI Number Information
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NPI Number | 1962853564
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Entity Type | Individual
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Provider Name | RYAN BAXTER DMD
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Gender | Male
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Dates
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Enumeration Date | 06/24/2016
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 607 INDIAN HEALTH RD
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City | PINE RIDGE
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State | SD
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Zip | 57770-3169
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Country | US
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Telephone | 605-867-5131
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Fax |
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Provider Business Mailing Address
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Address Line | 2004 NOAH STREET
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City | RAPID CITY
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State | SD
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Zip | 57703
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Country | US
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Telephone | 605-381-7284
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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 | 00204006
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DD5145
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D1410
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License Number State | SD
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