Provider Demographics
NPI:1477641025
Name:DUVAL, RYAN C (DMD , MSD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:C
Last Name:DUVAL
Suffix:
Gender:M
Credentials:DMD , MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14269 N 87TH ST STE 108
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3694
Mailing Address - Country:US
Mailing Address - Phone:509-312-0800
Mailing Address - Fax:
Practice Address - Street 1:14269 N 87TH ST STE 108
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-3694
Practice Address - Country:US
Practice Address - Phone:509-312-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000102341223E0200X
ORD98631223E0200X
AZD0106271223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics