Provider Demographics
NPI:1366638140
Name:DONLEY, RYAN WALTER (DMD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:WALTER
Last Name:DONLEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13250 E TRANSTAR TRL
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:AZ
Mailing Address - Zip Code:85641-6036
Mailing Address - Country:US
Mailing Address - Phone:520-647-7677
Mailing Address - Fax:
Practice Address - Street 1:13190 E COLOSSAL CAVE RD STE 150
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:AZ
Practice Address - Zip Code:85641-6036
Practice Address - Country:US
Practice Address - Phone:520-762-3236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ73951223G0001X
FLDN 180291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice