Provider Demographics
NPI:1871768853
Name:DANIEL J RIES, DMD, PC
Entity type:Organization
Organization Name:DANIEL J RIES, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:RIES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-665-8116
Mailing Address - Street 1:1201 SE 223RD AVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-2574
Mailing Address - Country:US
Mailing Address - Phone:503-665-8116
Mailing Address - Fax:
Practice Address - Street 1:1201 SE 223RD AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-2574
Practice Address - Country:US
Practice Address - Phone:503-665-8116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6196261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1386715910OtherNPI ENTITY TYPE 1 INDIVIDUAL