Provider Demographics
NPI:1144870676
Name:MARINER, RYAN M (DDS)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:M
Last Name:MARINER
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 1:201 BELT ST SUITE A
Mailing Address - Street 2:
Mailing Address - City:SNOW HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21863
Mailing Address - Country:US
Mailing Address - Phone:410-632-2551
Mailing Address - Fax:410-632-2561
Practice Address - Street 1:201 BELT ST SUITE A
Practice Address - Street 2:
Practice Address - City:SNOW HILL
Practice Address - State:MD
Practice Address - Zip Code:21863
Practice Address - Country:US
Practice Address - Phone:410-632-2551
Practice Address - Fax:410-632-2561
Is Sole Proprietor?:No
Enumeration Date:2019-09-17
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD169291223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119591300Medicaid