Provider Demographics
NPI:1417027301
Name:DAVIS, RYAN BARNELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:BARNELL
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 E MAIN ST #1
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043
Mailing Address - Country:US
Mailing Address - Phone:801-768-9241
Mailing Address - Fax:801-768-1468
Practice Address - Street 1:216 E MAIN ST #1
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043
Practice Address - Country:US
Practice Address - Phone:801-768-9241
Practice Address - Fax:801-768-1468
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1427079922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist