Individual
DR. MARK DANIEL RYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2133 PEPPERRELL ST BLDG 3352, JBSA LACKLAND, TX 78236-5313
(210) 292-6258
(210) 292-2618
Mailing address
PSC 808 BOX 19, FPO, AE 09618-0001
(081) 811-6000
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
019029011
IL
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
019.029011
IL
Other
Enumeration date
12/13/2012
Last updated
07/28/2023
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