Provider Demographics
NPI:1730418211
Name:BURKE, RYAN P (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:P
Last Name:BURKE
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 W 40TH ST
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-2001
Mailing Address - Country:US
Mailing Address - Phone:201-823-2200
Mailing Address - Fax:201-823-8588
Practice Address - Street 1:68 W 40TH ST
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-2001
Practice Address - Country:US
Practice Address - Phone:201-823-2200
Practice Address - Fax:201-823-8588
Is Sole Proprietor?:No
Enumeration Date:2009-12-13
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI024271001223G0001X
NJ61961223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No1223G0001XDental ProvidersDentistGeneral Practice