MEDICARE: RYAN SHANE DOWLING D.M.D.

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	1223G0001X	General Practice Dentistry	6241883-9922	UT

General Provider Information

NPI Number	:	1245424498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN SHANE DOWLING D.M.D.

Provider Business Mailing Address
First Line	:	210 N 2475 W
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84601-2235
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2180 FORT UNION BLVD
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-3148
Country	:	US
Telephone Number	:	801-944-4141
Fax Number	:

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

Provider Enumeration Date	:	08/30/2007
Last Update Date	:	08/30/2007

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