Provider Demographics
NPI:1659500940
Name:LAVENE, RYAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:LAVENE
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 1:2152 MCCULLOCH BLVD N STE C
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-6805
Mailing Address - Country:US
Mailing Address - Phone:928-854-5551
Mailing Address - Fax:928-733-6128
Practice Address - Street 1:2152 MCCULLOCH BLVD N STE C
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-6805
Practice Address - Country:US
Practice Address - Phone:928-854-5551
Practice Address - Fax:928-733-6128
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ87931223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics