Provider Demographics
NPI:1538853171
Name:MOYLAN, RYAN JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:JAMES
Last Name:MOYLAN
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 1:1700 BLAIRS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-2033
Mailing Address - Country:US
Mailing Address - Phone:319-396-3596
Mailing Address - Fax:
Practice Address - Street 1:1700 BLAIRS FERRY RD
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-2033
Practice Address - Country:US
Practice Address - Phone:319-396-3596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-10100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist