Provider Demographics
NPI:1316101066
Name:ALLRED, RYAN TIM (DMD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:TIM
Last Name:ALLRED
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21370 SW LANGER FARMS PKWY
Mailing Address - Street 2:#142 BOX 419
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140
Mailing Address - Country:US
Mailing Address - Phone:503-858-4881
Mailing Address - Fax:503-914-6685
Practice Address - Street 1:21370 SW LANGER FARMS PKWY
Practice Address - Street 2:#142 BOX 419
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140
Practice Address - Country:US
Practice Address - Phone:503-858-4881
Practice Address - Fax:503-914-6685
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 60078814122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist