Provider Demographics
NPI:1225713852
Name:GOULD, RYAN WELCH (DMD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:WELCH
Last Name:GOULD
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 EWING ST STE B16
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-2755
Mailing Address - Country:US
Mailing Address - Phone:609-921-0034
Mailing Address - Fax:
Practice Address - Street 1:601 EWING ST STE B16
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-2755
Practice Address - Country:US
Practice Address - Phone:609-921-0034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2025-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILD00213122300000X, 390200000X
NJ22DI03017400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program