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Individual
RYAN PATRICK MOONEYHAM
Active
Individual
RYAN PATRICK MOONEYHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
173
NE
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DDS-09792
IA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DNF000472
GA
390200000X
Student in an Organized Health Care Education/Training Program
Primary
DDS-09792
IA
Other
Enumeration date
12/14/2020
Last updated
02/03/2026
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