MEDICARE: DR. MICHAEL S RYCKMAN DMD, MS

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	30-022720	OH

General Provider Information

NPI Number	:	1891920351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL S RYCKMAN DMD, MS

Provider Business Mailing Address
First Line	:	1007 SHROYER RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45419-3635
Country	:	US
Telephone Number	:	937-294-1001
Fax Number	:	937-294-0798

Provider Business Practice Location Address
First Line	:	1007 SHROYER RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45419-3635
Country	:	US
Telephone Number	:	937-294-1001
Fax Number	:	937-294-0798

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

Provider Enumeration Date	:	05/27/2009
Last Update Date	:	05/27/2009

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