Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 25908 | TX |
N | 1223S0112X | Oral and Maxillofacial Surgeon | D010221 | AZ |
N | 204E00000X | Oral & Maxillofacial Surgeon | 30 024690 | OH |
NPI | 1285952895 |
---|---|
Provider Name | Ryan Mirchel |
First Address | Dallas, TX 75208-1953 |
Second Address | Dallas, TX 75208-1953 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2010 |
Last Update Date | 22/01/2022 |