Individual
DR. RYAN M. DIEPENBROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
7845 CARNEGIE BLVD STE A, FORT WAYNE, IN 46804-5792
(260) 423-2340
Mailing address
101 BODIN CIR, FAIRFIELD, CA 94535-1809
(707) 423-7085
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
30-022164
OH
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
12012587A
IN
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
63091
CA
Other
Enumeration date
10/12/2006
Last updated
11/25/2025
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