Provider Demographics
NPI:1871908673
Name:PARNELL, RYAN (DDS, MD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:PARNELL
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7633 E JEFFERSON AVE
Mailing Address - Street 2:SUITE 70
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48214-3730
Mailing Address - Country:US
Mailing Address - Phone:313-499-4775
Mailing Address - Fax:313-499-4953
Practice Address - Street 1:4185 TECHNOLOGY FOREST BLVD STE 100
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-2004
Practice Address - Country:US
Practice Address - Phone:281-367-2001
Practice Address - Fax:281-296-9539
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-01
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX344691223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty