Provider Demographics
NPI:1902535826
Name:GREENWAY, RYAN ALEXANDER (DDS)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:ALEXANDER
Last Name:GREENWAY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 HARBORSIDE DR
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550
Mailing Address - Country:US
Mailing Address - Phone:409-772-6783
Mailing Address - Fax:
Practice Address - Street 1:1005 HARBORSIDE DR
Practice Address - Street 2:5TH FLOOR
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550
Practice Address - Country:US
Practice Address - Phone:409-772-6783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20220187591223G0001X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1223G0001XDental ProvidersDentistGeneral Practice