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Individual
DR. RYAN WISDOM
Active
Individual
DR. RYAN WISDOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
059915
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/25/2017
Last updated
12/06/2018
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