Healthcare Provider Details

I. General information

NPI: 1689147159
Provider Name (Legal Business Name): RYAN MCNAMARA DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2019
Last Update Date: 01/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15965 NE 85TH ST STE 100
REDMOND WA
98052-3593
US

IV. Provider business mailing address

15965 NE 85TH ST STE 100
REDMOND WA
98052-3593
US

V. Phone/Fax

Practice location:
  • Phone: 425-898-4604
  • Fax: 425-898-4570
Mailing address:
  • Phone: 425-898-4604
  • Fax: 425-898-4570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RYAN P MCNAMARA
Title or Position: OWNER
Credential: DDS
Phone: 425-898-4604