MEDICARE: STUART RYAN 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
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	12012483A	IN

General Provider Information

NPI Number	:	1679135685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STUART RYAN DDS

Provider Business Mailing Address
First Line	:	11921 LAKESIDE DR
Second Line	:
City	:	FISHERS
State	:	IN
Zip	:	46038-1316
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11921 LAKESIDE DR
Second Line	:
City	:	FISHERS
State	:	IN
Zip	:	46038-1316
Country	:	US
Telephone Number	:	317-594-0888
Fax Number	:

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

Provider Enumeration Date	:	07/01/2019
Last Update Date	:	07/01/2019

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Directions to “ STUART RYAN DDS” Practice Location

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