Active NPI
Ryan Bumper Lee, D.D.S.
- Oral and Maxillofacial Surgery (Dentist)
- Davenport, IA
National Provider Identifier
1396972709
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)
- License
- 08664
- Practice address
- 5345 Spring St
Davenport, IA 52807-2764 - Phone
- (563) 359-1601
- NPI assigned
- Jun 12, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | 08664 | IA | |
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 08664 | IA | Primary |
Addresses
Primary practice location
5345 Spring St
Davenport, IA 52807-2764
Mailing address
5345 Spring St
Davenport, IA 52807-2764
Phone (563) 359-1601
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective May 22, 2020 through May 22, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 08664 | IA | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1244764800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578614400000",
"number": "1396972709",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5345 SPRING ST",
"city": "DAVENPORT",
"state": "IA",
"postal_code": "528072764",
"telephone_number": "563-359-1601"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5345 SPRING ST",
"city": "DAVENPORT",
"state": "IA",
"postal_code": "528072764",
"telephone_number": "563-359-1601"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "RYAN",
"middle_name": "BUMPER",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-06-12",
"last_updated": "2020-01-10",
"certification_date": "2020-01-10",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "IA",
"license": "08664",
"primary": false
},
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "IA",
"license": "08664",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Davenport, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.