Basic Information
Provider Information
NPI: 1083840748
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STANGER
FirstName: RYAN
MiddleName: T
NamePrefix: DR.
NameSuffix:  
Credential: DMD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6601 S RURAL RD
Address2: STE #120
City: TEMPE
State: AZ
PostalCode: 852833747
CountryCode: US
TelephoneNumber: 4804560821
FaxNumber:  
Practice Location
Address1: 6601 S RURAL RD
Address2: STE #120
City: TEMPE
State: AZ
PostalCode: 852833747
CountryCode: US
TelephoneNumber: 4804560821
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/08/2009
LastUpdateDate: 07/21/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000XD7754AZY Dental ProvidersDentist 

No ID Information.


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