Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 2901009648 | MI |
NPI | 1003093469 |
---|---|
Provider Name | Dr. Terrence Wayne Ryckman |
First Address | Owosso, MI 48867-3044 |
Second Address | Owosso, MI 48867-3044 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2008 |
Last Update Date | 29/01/2008 |