Healthcare Provider Details

I. General information

NPI: 1699688424
Provider Name (Legal Business Name): J RYAN MOSES DMD & MYRIAM HAMIEH DMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16600 SE 15TH ST UNIT A
VANCOUVER WA
98683-9502
US

IV. Provider business mailing address

16600 SE 15TH ST UNIT A
VANCOUVER WA
98683-9502
US

V. Phone/Fax

Practice location:
  • Phone: 360-514-0055
  • Fax: 360-514-0095
Mailing address:
  • Phone: 360-514-0055
  • Fax: 360-514-0095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JESSE RYAN MOSES
Title or Position: OWNER
Credential: DMD
Phone: 503-490-0654