Ryan P Lemert, DMD
Individual provider Active NPI General Practice Dentistry · Randle, WA
NPI 1497987473 · NPPES record last updated Apr 9, 2021
Key facts
- NPI
- 1497987473
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- D9326 (OR)
- Practice address
- 10109 US Hwy 12
Randle, WA 98377 - Phone
- (888) 468-0022
- Fax
- (541) 504-3907
- NPI assigned
- Aug 10, 2009
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150622000403 | WA | Order and Referring Only - Dentist |
2668783481 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D9326 | OR | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Randle Dental Clinic | Past |
Accepting new patients | |
| Advantage Dental Clinics, LLC | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D9326 | OR | Yes |
Addresses
Primary practice location
10109 US Hwy 12
Randle, WA 98377
Mailing address
PO Box 490
Redmond, OR 97756-0092
Phone (888) 468-0022
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500609291 | Medicaid | OR |
Other providers in Randle, WA
- Daryl Gene Conklin
- Emily Olivia Dames
- Pamala Hedglin
- Lewis County Fire Protection District 14
- Lewis County Fire Protection District 14
- Lewis County Hospital District No. 1
- Lewis County Hospital District No. 1
- Travis Podbilski
All providers in Randle, WA · General Practice Dentistry in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 9, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.