Provider Demographics
NPI:1841346632
Name:DONNELLY, RYAN LEE (DMD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:LEE
Last Name:DONNELLY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:RYAN
Other - Middle Name:
Other - Last Name:DONNELY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12100 SE STEVENS COURT, SUITE 101
Mailing Address - Street 2:RYAN L. DONNELLY CO MT. SCOTT FAMILY DENTAL
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97086
Mailing Address - Country:US
Mailing Address - Phone:503-353-9000
Mailing Address - Fax:503-786-1873
Practice Address - Street 1:12100 SE STEVENS COURT, SUITE 101
Practice Address - Street 2:RYAN L DONNELLY
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97086
Practice Address - Country:US
Practice Address - Phone:503-353-9000
Practice Address - Fax:503-786-1873
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD85991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice