Provider Demographics
NPI:1780716522
Name:RYAN, MICHAEL J (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:RYAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 E SHORE TRL
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-2201
Mailing Address - Country:US
Mailing Address - Phone:973-729-0591
Mailing Address - Fax:
Practice Address - Street 1:73 OAK RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07438
Practice Address - Country:US
Practice Address - Phone:973-697-3900
Practice Address - Fax:973-697-5448
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ120389122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist