Individual
DR. RYAN CHASE HACKENBERGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
19511 MACK AVE, GROSSE POINTE WOODS, MI 48236-2836
(313) 882-7152
Mailing address
1052 YORKSHIRE RD, GROSSE POINTE PARK, MI 48230-1450
(313) 670-2486
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2901602287
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
MI
Other
Enumeration date
07/05/2024
Last updated
07/17/2024
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