Healthcare Provider Details

I. General information

NPI: 1174048060
Provider Name (Legal Business Name): RYAN O'DONNELL DDS, MDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2017
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 OLIVE WAY STE 810
SEATTLE WA
98101-1836
US

IV. Provider business mailing address

12106 SE 26TH ST
BELLEVUE WA
98005-4119
US

V. Phone/Fax

Practice location:
  • Phone: 206-628-0404
  • Fax:
Mailing address:
  • Phone: 258-908-1834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60769832
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: