MEDICARE: J.D RYAN DDS, INC.

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	30013969	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710157250
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J.D RYAN DDS, INC.

Provider Business Mailing Address
First Line	:	779 HARRISBURG PIKE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43223-2113
Country	:	US
Telephone Number	:	614-276-6226
Fax Number	:	614-276-6129

Provider Business Practice Location Address
First Line	:	779 HARRISBURG PIKE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43223-2113
Country	:	US
Telephone Number	:	614-276-6226
Fax Number	:	614-276-6129

Authorized Official
Title or Position	:	COMPANY MANAGER
Name	:	MRS. COLLEEN R AVERY
Credential	:
Telephone Number	:	614-276-6226

Provider Enumeration Date	:	03/11/2008
Last Update Date	:	03/11/2008

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