Healthcare Provider Details

I. General information

NPI: 1477641025
Provider Name (Legal Business Name): RYAN C. DUVAL D.M.D. , M.S.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 05/21/2020
Certification Date: 05/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14269 N 87TH ST STE 108
SCOTTSDALE AZ
85260-3694
US

IV. Provider business mailing address

14269 N 87TH ST STE 108
SCOTTSDALE AZ
85260-3694
US

V. Phone/Fax

Practice location:
  • Phone: 509-312-0800
  • Fax:
Mailing address:
  • Phone: 509-312-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDE00010234
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberD9863
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberD010627
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: