Provider Demographics
NPI:1366765687
Name:DAVIS, GEORGE RYAN (DMD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:RYAN
Last Name:DAVIS
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 1:244 E ELLENDALE AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-1523
Mailing Address - Country:US
Mailing Address - Phone:503-400-6994
Mailing Address - Fax:503-623-7598
Practice Address - Street 1:244 E ELLENDALE AVE STE 4
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-1523
Practice Address - Country:US
Practice Address - Phone:503-400-6994
Practice Address - Fax:503-623-7598
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD103531223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice