Vistica, Jeremy Ryan

Vistica, Jeremy Ryan is an individual health care provider with primary practice located at 5512 Maryport Dr , Huntington Beach CA 92649-4821. He recently has 2 registered licenses in different health care specialties including Dental Providers / Dentist, Dental Providers / Orthodontics and Dentofacial Orthopedics. Dental Providers / Orthodontics and Dentofacial Orthopedics is his primary health care specialty. Vistica, Jeremy Ryan can be contacted via phone (503) 706-5944.

Contact Information

Primary practice address
5512 Maryport Dr Huntington Beach CA 92649-4821
Phone: (503) 706-5944
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X 0401417561 Virginia
Dental Providers / Dentist 122300000X D8993 Oregon
Dental Providers / Orthodontics and Dentofacial Orthopedics 1223X0400X 109231 California

Profile Details

NPI number 1639368582
LBN Legal business name Vistica, Jeremy Ryan
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 16th, 2007
Last updated Oct 1st, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1639368582 NPPES
Oregon MEDICAID 500637605

Popular Providers