Provider Demographics
NPI:1710449749
Name:DAHLBERG, RYAN KENDALL (MD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:KENDALL
Last Name:DAHLBERG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2400 UNSER BLVD SE STE 8100
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-3392
Mailing Address - Country:US
Mailing Address - Phone:505-253-6100
Mailing Address - Fax:505-253-6186
Practice Address - Street 1:2400 UNSER BLVD SE STE 8100
Practice Address - Street 2:ORTHOPEDICS & ORTHOPEDIC SURGERY
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-3392
Practice Address - Country:US
Practice Address - Phone:505-253-6100
Practice Address - Fax:505-253-6186
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-31
Last Update Date:2025-09-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2025-0525207XS0106X
MA1018733207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery