Active NPI
Ryan L Reese, D.M.D
- Endodontics
- Wilsonville, OR
National Provider Identifier
1548516958
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- D9765
- Practice address
- 8309 SW Main St
Suite 100
Wilsonville, OR 97070-5550 - Phone
- (503) 682-0550
- NPI assigned
- Aug 3, 2012
- Last updated
- Dec 17, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | D9765 | OR | Primary |
Addresses
Primary practice location
8309 SW Main St
Suite 100
Wilsonville, OR 97070-5550
Mailing address
28626 SW Terrene Lane
Wilsonville, OR 97070
Phone (216) 990-8868
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151125000363 | OR | Order and Referring Only - Other (Physician) | 0345540217 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D9765 | OR | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1343952000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1387238400000",
"number": "1548516958",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "28626 SW TERRENE LANE",
"city": "WILSONVILLE",
"state": "OR",
"postal_code": "97070",
"telephone_number": "216-990-8868"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8309 SW MAIN ST",
"address_2": "SUITE 100",
"city": "WILSONVILLE",
"state": "OR",
"postal_code": "970705550",
"telephone_number": "503-682-0550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REESE",
"first_name": "RYAN",
"middle_name": "L",
"credential": "D.M.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-08-03",
"last_updated": "2013-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "OR",
"license": "D9765",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wilsonville, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.