Provider Demographics
NPI:1548516958
Name:REESE, RYAN L (DMD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:L
Last Name:REESE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28626 SW TERRENE LANE
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070
Mailing Address - Country:US
Mailing Address - Phone:216-990-8868
Mailing Address - Fax:
Practice Address - Street 1:8309 SW MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-5550
Practice Address - Country:US
Practice Address - Phone:503-682-0550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-03
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD97651223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics