Provider Demographics
NPI:1902174857
Name:RYAN, ROSEMARY B (CDA, RDH,MPH)
Entity Type:Individual
Prefix:MS
First Name:ROSEMARY
Middle Name:B
Last Name:RYAN
Suffix:
Gender:F
Credentials:CDA, RDH,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 BURWELL RD
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06057-4110
Mailing Address - Country:US
Mailing Address - Phone:860-628-4751
Mailing Address - Fax:860-426-2509
Practice Address - Street 1:2279 MOUNT VERNON RD
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-1007
Practice Address - Country:US
Practice Address - Phone:860-628-4751
Practice Address - Fax:860-628-6444
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003706124Q00000X
CT189888126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No126800000XDental ProvidersDental Assistant