1316101066 NPI number — DR. RYAN TIM ALLRED DMD

Table of content: DR. RYAN TIM ALLRED DMD (NPI 1316101066)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316101066 NPI number — DR. RYAN TIM ALLRED DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALLRED
Provider First Name:
RYAN
Provider Middle Name:
TIM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316101066
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21370 SW LANGER FARMS PKWY
Provider Second Line Business Mailing Address:
#142 BOX 419
Provider Business Mailing Address City Name:
SHERWOOD
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97140
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-858-4881
Provider Business Mailing Address Fax Number:
503-914-6685

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21370 SW LANGER FARMS PKWY
Provider Second Line Business Practice Location Address:
#142 BOX 419
Provider Business Practice Location Address City Name:
SHERWOOD
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-858-4881
Provider Business Practice Location Address Fax Number:
503-914-6685
Provider Enumeration Date:
07/11/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DE 60078814 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)