Provider Demographics
NPI:1609869577
Name:HUGHES, RYAN J (DDS, MS)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:J
Last Name:HUGHES
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 N STATE ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-3956
Mailing Address - Country:US
Mailing Address - Phone:503-635-3483
Mailing Address - Fax:503-699-0345
Practice Address - Street 1:8 N STATE ST
Practice Address - Street 2:SUITE 203
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-3956
Practice Address - Country:US
Practice Address - Phone:503-635-3483
Practice Address - Fax:503-699-0345
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORD81341223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR023104Medicaid