MEDICARE: JOHN W RYAN DMD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	NJ10190000	NJ

General Provider Information

NPI Number	:	1033502968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN W RYAN DMD PA

Provider Business Mailing Address
First Line	:	116 SPRING ST
Second Line	:
City	:	RED BANK
State	:	NJ
Zip	:	07701-2426
Country	:	US
Telephone Number	:	732-747-3848
Fax Number	:	732-747-4682

Provider Business Practice Location Address
First Line	:	116 SPRING ST
Second Line	:
City	:	RED BANK
State	:	NJ
Zip	:	07701-2426
Country	:	US
Telephone Number	:	732-747-3848
Fax Number	:	732-747-4682

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. JOHN WILLIAM RYAN
Credential	:	DMD
Telephone Number	:	732-747-3848

Provider Enumeration Date	:	03/17/2015
Last Update Date	:	03/17/2015

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