Provider Demographics
NPI:1871163402
Name:TODOROVICH, RYAN WILLIAM (DDS)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:WILLIAM
Last Name:TODOROVICH
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 1:11766 177TH ST W
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-5201
Mailing Address - Country:US
Mailing Address - Phone:952-715-0685
Mailing Address - Fax:
Practice Address - Street 1:608 TECHNOLOGY DR
Practice Address - Street 2:
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-2846
Practice Address - Country:US
Practice Address - Phone:751-388-1806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-27
Last Update Date:2021-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND14602122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist