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Ryan Massinople, DDS

Dentist, General Practice in Chicago, IL. Individual provider (NPI-1).

NPI number1083307136
StatusActive
Last updated in NPPESJun 2, 2023

Details

NPI
1083307136
Entity type
Individual (NPI-1)
Name
Ryan Massinople
Credential
DDS
Sex
Male
Sole proprietor
No
Enumeration date
Jun 2, 2023
Certification date
Apr 13, 2023
Last updated
Jun 2, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1223G0001X Dentist, General Practice019034295ILYes

Practice location

1259 S Wabash Ave
Chicago, IL 60605-2412

Phone 312-846-6752

Mailing address

1 Upper Middle Rd
Charleston, WV 25314-1439

Phone 304-549-9177

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