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NPI Code Detail

MEDICARE: DR. RYAN LEE GAFFNER DDS

MEDICARE: DR. RYAN LEE GAFFNER DDS
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
1122300000XDentist0401418535VA

General Provider Information

NPI Number : 1407532500
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RYAN LEE GAFFNER DDS
Provider Business Mailing Address
First Line : 15210 BRAETON DR APT 305
Second Line :
City : MIDLOTHIAN
State : VA
Zip : 23114-3292
Country : US
Telephone Number : 703-678-9925
Fax Number :
Provider Business Practice Location Address
First Line : 3250 ANDERSON HWY
Second Line :
City : POWHATAN
State : VA
Zip : 23139-7307
Country : US
Telephone Number : 804-598-2600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2023
Last Update Date : 06/23/2023

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