Active NPI
Ryan Lavene, DDS
- Endodontics
- Lake Havasu City, AZ
National Provider Identifier
1659500940
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 8793
- Practice address
- 2152 McCulloch Blvd N Ste C
Lake Havasu City, AZ 86403-6805 - Phone
- (928) 854-5551
- Fax
- (928) 733-6128
- NPI assigned
- Jul 7, 2009
- Last updated
- Oct 22, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 8793 | AZ | Primary |
Addresses
Primary practice location
2152 McCulloch Blvd N Ste C
Lake Havasu City, AZ 86403-6805
Mailing address
2152 McCulloch Blvd N Ste C
Lake Havasu City, AZ 86403-6805
Phone (928) 854-5551
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective May 24, 2021 through May 24, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8793 | AZ | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dental Specialists of NW Arizona | Endodontics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1246924800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571702400000",
"number": "1659500940",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2152 MCCULLOCH BLVD N STE C",
"city": "LAKE HAVASU CITY",
"state": "AZ",
"postal_code": "864036805",
"telephone_number": "928-854-5551",
"fax_number": "928-733-6128"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2152 MCCULLOCH BLVD N STE C",
"city": "LAKE HAVASU CITY",
"state": "AZ",
"postal_code": "864036805",
"telephone_number": "928-854-5551",
"fax_number": "928-733-6128"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAVENE",
"first_name": "RYAN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-07-07",
"last_updated": "2019-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "AZ",
"license": "8793",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Havasu City, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.