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General NPI Number Information
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NPI Number | 1972349975
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Entity Type | Individual
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Provider Name | RYAN HENDERSON ARCHIBALD DMD
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Gender | Male
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Dates
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Enumeration Date | 07/08/2024
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Last Update Date | 01/13/2026
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Provider Practice Location Address
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Address Line | 2803 N BOGUS BASIN RD
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City | BOISE
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State | ID
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Zip | 83702-0913
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Country | US
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Telephone | 208-343-1393
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Fax |
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Provider Business Mailing Address
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Address Line | 2150 E BELL RD UNIT 1123
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City | PHOENIX
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State | AZ
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Zip | 85022-2978
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6571486
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D012168
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License Number State | AZ
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