1255139572 NPI number — NORTHWEST STRONG FAMILY DENTISTRY

Table of content: YURI RYBIN JR. PTA (NPI 1285142109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255139572 NPI number — NORTHWEST STRONG FAMILY DENTISTRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWEST STRONG FAMILY DENTISTRY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1255139572
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15047 SE PEBBLE BEACH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAPPY VALLEY
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97086-7330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-960-5872
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
608 WEST B STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RAINIER
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
35-556-0002
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/04/2025

Additional Information

Authorized Official

Authorized Official Last Name:
STRONG
Authorized Official First Name:
BRAD
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
801-960-5872

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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