Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 24556 | TX |
N | 122300000X | Dentist | 9996 | CO |
NPI | 1003048992 |
---|---|
Provider Name | Laura Ryan |
First Address | Allen, TX 75002-3105 |
Second Address | Allen, TX 75002-3105 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2009 |
Last Update Date | 09/11/2011 |