Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | DE61017384 | WA |
Y | 204E00000X | Oral & Maxillofacial Surgeon | MD60918839 | WA |
NPI | 1023451655 |
---|---|
Provider Name | Dr. Matthew Ryskalczyk |
First Address | Edmonds, WA 98026-7536 |
Second Address | Edmonds, WA 98026-7536 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2013 |
Last Update Date | 14/08/2020 |