Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | M817 | SD |
NPI | 1003009903 |
---|---|
Provider Name | Dr. Ryan K Vanlaecken |
First Address | Watertown, SD 57201-3712 |
Second Address | Watertown, SD 57201-1898 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2007 |
Last Update Date | 19/05/2020 |