Provider Demographics
NPI:1043300411
Name:JOHNSTUN, RYAN C (DDS)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:C
Last Name:JOHNSTUN
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 1:778 CIBOLO VALLEY DR STE 119
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-4553
Mailing Address - Country:US
Mailing Address - Phone:360-436-1008
Mailing Address - Fax:360-436-1147
Practice Address - Street 1:778 CIBOLO VALLEY DR STE 119
Practice Address - Street 2:
Practice Address - City:CIBOLO
Practice Address - State:TX
Practice Address - Zip Code:78108-4553
Practice Address - Country:US
Practice Address - Phone:210-436-8823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice