Healthcare Provider Details

I. General information

NPI: 1952296709
Provider Name (Legal Business Name): RYAN ODONNELL DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2025
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: 425-890-8183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: RYAN O'DONNELL
Title or Position: OWNER
Credential: DDS
Phone: 425-890-8183