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Organization
DENTAL SPECIALISTS OF NW ARIZONA
Active
Organization
DENTAL SPECIALISTS OF NW ARIZONA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RYAN LAVENE D.D.S. (ENDODONTIST)
(928) 854-5551
Entity
Organization
Contact information
Practice address
2152 MCCULLOCH BLVD N STE C, LAKE HAVASU CITY, AZ 86403-6805
(928) 854-5551
Mailing address
2152 MCCULLOCH BLVD N STE C, LAKE HAVASU CITY, AZ 86403-6805
(928) 854-5551
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
8793
AZ
1223P0300X
Periodontics
Primary
8823
AZ
Other
Enumeration date
12/16/2015
Last updated
12/16/2015
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