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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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