Healthcare Provider Details

I. General information

NPI: 1609275007
Provider Name (Legal Business Name): RYAN BRIDGES D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2014
Last Update Date: 09/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30040 SW BOONES FERRY RD STE 20
WILSONVILLE OR
97070
US

IV. Provider business mailing address

6477 NW CONNERY TER
PORTLAND OR
97229-1653
US

V. Phone/Fax

Practice location:
  • Phone: 503-682-4500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD10108
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: