Provider Demographics
NPI:1922560093
Name:GAW, RYAN (DDS)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:GAW
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 1:2022 S ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-1589
Mailing Address - Country:US
Mailing Address - Phone:614-954-2361
Mailing Address - Fax:
Practice Address - Street 1:160 CAPP ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-1210
Practice Address - Country:US
Practice Address - Phone:415-417-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-05
Last Update Date:2024-01-03
Deactivation Date:2021-01-06
Deactivation Code:
Reactivation Date:2024-01-03
Provider Licenses
StateLicense IDTaxonomies
CA105696122300000X
NVS3-3811223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist