Provider Demographics
NPI:1629137435
Name:O'DONNELL, RYAN DANIEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:DANIEL
Last Name:O'DONNELL
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 1:6868 E BECKER LN STE 102
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-6708
Mailing Address - Country:US
Mailing Address - Phone:480-315-0506
Mailing Address - Fax:
Practice Address - Street 1:6868 E BECKER LN STE 102
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-6708
Practice Address - Country:US
Practice Address - Phone:480-452-8384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ67031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice