# RYAN BUSHMAN DMD & CHASE DAVIS DDS PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Medical Lake Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679213375
- **Authorized official:** ASHLIE RIVERSON (BILLING CREDENTIALING MANAGER)
- **Authorized official phone:** (509) 924-0381

## Contact information

- **Practice address:** 123 N BROWER ST, MEDICAL LAKE, WA 99022-5109
- **Practice address phone:** (509) 299-5171
- **Mailing address:** 1222 N PINES RD STE 101, SPOKANE VALLEY, WA 99206-4939
- **Mailing address phone:** (509) 924-0381
- **Mailing address fax:** (509) 893-9485

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | Yes |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 03/30/2022
- **Last updated:** 04/18/2022