Provider Demographics
NPI:1548831225
Name:RYAN, REBECCA BETTY (DDS)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:BETTY
Last Name:RYAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6309 S LIMERICK CIR
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-3212
Mailing Address - Country:US
Mailing Address - Phone:605-759-2468
Mailing Address - Fax:
Practice Address - Street 1:5121 S SOLBERG AVE STE 120
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2246
Practice Address - Country:US
Practice Address - Phone:605-339-2955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-05
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD13201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice