Provider Demographics
NPI:1568572600
Name:RIRIE, DONALD WATSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:WATSON
Last Name:RIRIE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15495 SW SEQUOIA PKWY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97224-6100
Mailing Address - Country:US
Mailing Address - Phone:503-684-8445
Mailing Address - Fax:503-620-2880
Practice Address - Street 1:15495 SW SEQUOIA PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97224-6100
Practice Address - Country:US
Practice Address - Phone:503-684-8445
Practice Address - Fax:503-620-2880
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD80871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice