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Individual

DR. RYAN LISANN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
474 BROADWAY APT 110, SOMERVILLE, MA 02145-2630
(617) 623-2223
Mailing address
73 RIVER ST APT 2B, CAMBRIDGE, MA 02139-3818
(631) 896-3506

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN1858741
MA

Other

Enumeration date
08/07/2020
Last updated
08/07/2020
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