Individual
RYAN CAMPBELL JAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
12110 PENDLETON PIKE, INDIANAPOLIS, IN 46236
(317) 826-1050
(317) 826-1065
Mailing address
12110 PENDLETON PIKE, INDIANAPOLIS, IN 46236
(317) 826-1050
(317) 826-1065
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12010606A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100071480A
—
IN
05
—
200460270A
—
IN
Enumeration date
05/24/2006
Last updated
03/02/2011
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