Individual
DR. RYAN JAMES DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD, MS
Contact information
Practice address
1717 W CANDLETREE DR STE A, PEORIA, IL 61614-1592
(309) 360-8502
Mailing address
1717 W CANDLETREE DR STE A, PEORIA, IL 61614-1592
(309) 360-8502
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
019.027.427
IL
1223P0300X
Periodontics
Primary
021.002357
IL
Other
Enumeration date
03/14/2008
Last updated
10/17/2012
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