MEDICARE: MICHAEL RYAN D.D.S

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	22742	TX

General Provider Information

NPI Number	:	1760645923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL RYAN D.D.S

Provider Business Mailing Address
First Line	:	720 E MAIN ST
Second Line	:	SUITE A
City	:	ALLEN
State	:	TX
Zip	:	75002-3105
Country	:	US
Telephone Number	:	972-727-5001
Fax Number	:	972-727-6335

Provider Business Practice Location Address
First Line	:	720 E MAIN ST
Second Line	:	SUITE A
City	:	ALLEN
State	:	TX
Zip	:	75002-3105
Country	:	US
Telephone Number	:	972-727-5001
Fax Number	:	972-727-6335

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

Provider Enumeration Date	:	07/08/2008
Last Update Date	:	11/09/2011

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