Provider Demographics
NPI:1053052688
Name:NATAL, DOUGLAS RYAN
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:RYAN
Last Name:NATAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 ARCH ST STE 303
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1432
Mailing Address - Country:US
Mailing Address - Phone:330-375-6262
Mailing Address - Fax:
Practice Address - Street 1:75 ARCH ST STE 303
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1432
Practice Address - Country:US
Practice Address - Phone:330-375-6262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12014059A122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program