Individual
RYAN COSTNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
598 E JACKSON BLVD STE 200, ERWIN, NC 28339-9632
(910) 230-5472
Mailing address
12450 CLEVELAND RD STE 203, GARNER, NC 27529-8355
(919) 277-7957
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10873
NC
1223G0001X
General Practice Dentistry
40161
IA
Other
Enumeration date
08/23/2016
Last updated
07/29/2021
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