MEDICARE: RYAN TYNG, DMD PROFESSIONAL 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	10399	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1780848176	OTHER	CO	INDIVIDUAL NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881149300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RYAN TYNG, DMD PROFESSIONAL INC

Provider Business Mailing Address
First Line	:	5955 DUBLIN BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-7474
Country	:	US
Telephone Number	:	719-596-3481
Fax Number	:	719-596-9114

Provider Business Practice Location Address
First Line	:	5955 DUBLIN BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-7474
Country	:	US
Telephone Number	:	719-596-3481
Fax Number	:	719-596-9114

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MARCIA GUEVARA
Credential	:
Telephone Number	:	719-596-3481

Provider Enumeration Date	:	08/25/2016
Last Update Date	:	02/27/2025

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