Provider Demographics
NPI:1457735201
Name:DAHLE, RYAN (DMD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:DAHLE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:782 S RIVER RD # 403
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-5716
Mailing Address - Country:US
Mailing Address - Phone:801-232-5628
Mailing Address - Fax:
Practice Address - Street 1:1276 E GEORGE WASHINGTON BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790
Practice Address - Country:US
Practice Address - Phone:435-900-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-10
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31031122300000X
UT5450784122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist