Provider Demographics
NPI:1447669247
Name:RYBAR, HEATHER (DDS)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:RYBAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21ST MEDICAL GROUP
Mailing Address - Street 2:559 VINCENT ST, SPACE BASE DELTA 1
Mailing Address - City:PETERSRON SPACE FORCE BASE
Mailing Address - State:CO
Mailing Address - Zip Code:80914
Mailing Address - Country:US
Mailing Address - Phone:630-621-2059
Mailing Address - Fax:
Practice Address - Street 1:21ST MEDICAL GROUP
Practice Address - Street 2:559 VINCENT ST, SPACE BASE DELTA 1
Practice Address - City:PETERSON SPACE FORCE BASE
Practice Address - State:CO
Practice Address - Zip Code:80914
Practice Address - Country:US
Practice Address - Phone:630-621-2059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-05
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0297751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice