Provider Demographics
NPI:1730247818
Name:RYAN, MARK P (DDS)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:P
Last Name:RYAN
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 1:1330 NEW HAMPSHIRE AVE NW
Mailing Address - Street 2:3-B
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-6350
Mailing Address - Country:US
Mailing Address - Phone:202-872-0022
Mailing Address - Fax:
Practice Address - Street 1:1330 NEW HAMPSHIRE AVE NW
Practice Address - Street 2:3-B
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-6350
Practice Address - Country:US
Practice Address - Phone:202-872-0022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN38511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice