Healthcare Provider Details

I. General information

NPI: 1730802588
Provider Name (Legal Business Name): RYAN A. MARTIN, DMD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 NW SHEVLIN PARK RD STE 140
BEND OR
97703-7195
US

IV. Provider business mailing address

2766 NW RAINBOW RIDGE DR
BEND OR
97703-8722
US

V. Phone/Fax

Practice location:
  • Phone: 541-595-8063
  • Fax:
Mailing address:
  • Phone: 775-881-8981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. RYAN MARTIN
Title or Position: OWNER
Credential: DMD
Phone: 775-881-8981