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Individual

DR. RYAN MASAO MIZUMOTO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DMD

Contact information

Practice address
55 CAREN AVE STE 270, WORTHINGTON, OH 43085-2515
(614) 885-7721
(614) 888-0284
Mailing address
6779 OAKFAIR AVE, COLUMBUS, OH 43235-2734
(206) 920-6173

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
019028088
IL
1223G0001X
General Practice Dentistry
30-023250
OH
1223P0700X
Prosthodontics
Primary
30-023250
OH

Other

Enumeration date
07/17/2009
Last updated
01/07/2019
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