Healthcare Provider Details

I. General information

NPI: 1780099713
Provider Name (Legal Business Name): NATHAN RISLEY D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2014
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 SE 3RD AVE
HILLSBORO OR
97123-4019
US

IV. Provider business mailing address

150 SE 3RD AVE
HILLSBORO OR
97123-4019
US

V. Phone/Fax

Practice location:
  • Phone: 503-213-1257
  • Fax:
Mailing address:
  • Phone: 503-213-1257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberD10460
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: