MEDICARE: RYAN D WOMACK MD DDS PLLC

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	261QS0112X	Oral and Maxillofacial Surgery Clinic/Center	DE.60280647	WA

General Provider Information

NPI Number	:	1932454030
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RYAN D WOMACK MD DDS PLLC

Provider Business Mailing Address
First Line	:	400 YAUGER WAY SW
Second Line	:	SUITE A
City	:	OLYMPIA
State	:	WA
Zip	:	98502-8139
Country	:	US
Telephone Number	:	360-754-9444
Fax Number	:	360-754-8335

Provider Business Practice Location Address
First Line	:	400 YAUGER WAY SW
Second Line	:	SUITE A
City	:	OLYMPIA
State	:	WA
Zip	:	98502-8139
Country	:	US
Telephone Number	:	360-754-9444
Fax Number	:	360-754-8335

Authorized Official
Title or Position	:	OWNER
Name	:	RYAN DAVID WOMACK
Credential	:	MD, DDS
Telephone Number	:	360-754-9444

Provider Enumeration Date	:	07/16/2012
Last Update Date	:	07/16/2012

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