Provider Demographics
NPI:1669781902
Name:CAUDILL, RYAN LEE (DMD, MSD, PA)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:LEE
Last Name:CAUDILL
Suffix:
Gender:M
Credentials:DMD, MSD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 N SYKES CREEK PKWY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-3492
Mailing Address - Country:US
Mailing Address - Phone:321-453-2535
Mailing Address - Fax:321-483-3181
Practice Address - Street 1:270 N SYKES CREEK PKWY
Practice Address - Street 2:SUITE 104
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-3492
Practice Address - Country:US
Practice Address - Phone:321-453-2535
Practice Address - Fax:321-483-3181
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN166801223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics