Provider Demographics
NPI:1265430821
Name:RIDGLEY, PATRICIA L (DMD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:RIDGLEY
Suffix:
Gender:F
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:PO BOX 1847
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-1847
Mailing Address - Country:US
Mailing Address - Phone:503-692-3747
Mailing Address - Fax:503-612-6948
Practice Address - Street 1:18803 SW BOONES FERRY RD
Practice Address - Street 2:STE 5
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8412
Practice Address - Country:US
Practice Address - Phone:503-692-3747
Practice Address - Fax:503-612-6948
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR54021223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
971432OtherMILITARY
971432OtherMILITARY