Individual provider Active NPI

Ryan R. Blair, D.M.D

  • General Practice Dentistry
  • Portland, OR
National Provider Identifier
1265649024
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
7887 Issued in OR
Practice address
3435 SE 75TH Ave
Portland, OR 97206-2407
Phone
(503) 777-5544
Fax
(503) 777-0460
NPI assigned
May 17, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 7887 OR Primary

Addresses

Primary practice location

3435 SE 75TH Ave
Portland, OR 97206-2407

Mailing address

3435 SE 75TH Ave
Portland, OR 97206-2407
Phone (503) 777-5544

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160421001222 OR Order and Referring Only - DentistPractitioner - Dentist 1658679832

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7887ORMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1265649024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3435 SE 75TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972062407",
            "telephone_number": "503-777-5544",
            "fax_number": "503-777-0460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3435 SE 75TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972062407",
            "telephone_number": "503-777-5544",
            "fax_number": "503-777-0460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAIR",
        "first_name": "RYAN",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "7887",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.