Healthcare Provider Details

I. General information

NPI: 1184546186
Provider Name (Legal Business Name): RYAN LEE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8914 N 91ST AVE
PEORIA AZ
85345-8396
US

IV. Provider business mailing address

9550 W NORTHERN AVE UNIT 3119
PEORIA AZ
85345-0013
US

V. Phone/Fax

Practice location:
  • Phone: 623-877-5700
  • Fax:
Mailing address:
  • Phone: 415-634-8076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD012885
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: