Individual
DEREK RYAN MICHAEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3316 SE 28TH TERRACE, TOPEKA, KS 66605-2457
(785) 266-9100
(785) 328-4729
Mailing address
2037 SE 29TH ST, TOPEKA, KS 66605-2457
(785) 267-9500
(785) 328-4729
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
61431
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
61431
KANSAS DENTAL LICENSE
KS
Enumeration date
06/18/2018
Last updated
05/19/2021
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