MEDICARE: DR. RYAN STEPHEN GUNN DMD

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	6643510-9922	UT

General Provider Information

NPI Number	:	1073713715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN STEPHEN GUNN DMD

Provider Business Mailing Address
First Line	:	409 S MAIN ST
Second Line	:	STE 1
City	:	CEDAR CITY
State	:	UT
Zip	:	84720-3448
Country	:	US
Telephone Number	:	610-331-4921
Fax Number	:

Provider Business Practice Location Address
First Line	:	409 S MAIN ST
Second Line	:	STE 1
City	:	CEDAR CITY
State	:	UT
Zip	:	84720-3448
Country	:	US
Telephone Number	:	610-331-4921
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2007
Last Update Date	:	07/20/2007

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