Healthcare Provider Details

I. General information

NPI: 1871768853
Provider Name (Legal Business Name): DANIEL J RIES, DMD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 SE 223RD AVE SUITE 140
GRESHAM OR
97030-2574
US

IV. Provider business mailing address

1201 SE 223RD AVE SUITE 140
GRESHAM OR
97030-2574
US

V. Phone/Fax

Practice location:
  • Phone: 503-665-8116
  • Fax:
Mailing address:
  • Phone: 503-665-8116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number6196
License Number StateOR

VII. Legacy identifiers

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

# 1
Identifier1386715910
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerNPI ENTITY TYPE 1 INDIVIDUAL

VIII. Authorized Official

Name: DANIEL JAMES RIES
Title or Position: DENTIST/OWNER
Credential: DMD
Phone: 503-665-8116