Provider Demographics
NPI:1679213375
Name:RYAN BUSHMAN DMD & CHASE DAVIS DDS PLLC
Entity Type:Organization
Organization Name:RYAN BUSHMAN DMD & CHASE DAVIS DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-924-0381
Mailing Address - Street 1:1222 N PINES RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-4939
Mailing Address - Country:US
Mailing Address - Phone:509-924-0381
Mailing Address - Fax:509-893-9485
Practice Address - Street 1:123 N BROWER ST
Practice Address - Street 2:
Practice Address - City:MEDICAL LAKE
Practice Address - State:WA
Practice Address - Zip Code:99022-5109
Practice Address - Country:US
Practice Address - Phone:509-299-5171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-30
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty