Healthcare Provider Details

I. General information

NPI: 1710449749
Provider Name (Legal Business Name): RYAN KENDALL DAHLBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2019
Last Update Date: 09/21/2025
Certification Date: 09/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 UNSER BLVD SE STE 8100 ORTHOPEDICS & ORTHOPEDIC SURGERY
RIO RANCHO NM
87124-3392
US

IV. Provider business mailing address

2400 UNSER BLVD SE STE 8100 PHS PROVIDER ENROLLMENT
RIO RANCHO NM
87124-3392
US

V. Phone/Fax

Practice location:
  • Phone: 505-253-6100
  • Fax: 505-253-6186
Mailing address:
  • Phone: 505-253-6100
  • Fax: 505-253-6186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberMD2025-0525
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number1018733
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: