Provider Demographics
NPI:1487943148
Name:DULDE, RYAN CHARLES (DDS)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:CHARLES
Last Name:DULDE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6191 S 108TH ST
Mailing Address - Street 2:
Mailing Address - City:HALES CORNERS
Mailing Address - State:WI
Mailing Address - Zip Code:53130-2524
Mailing Address - Country:US
Mailing Address - Phone:262-227-4518
Mailing Address - Fax:
Practice Address - Street 1:6191 S 108TH ST
Practice Address - Street 2:
Practice Address - City:HALES CORNERS
Practice Address - State:WI
Practice Address - Zip Code:53130-2524
Practice Address - Country:US
Practice Address - Phone:262-227-4518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6896-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist