Provider Demographics
NPI:1174048060
Name:O'DONNELL, RYAN (DDS, MDS)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:O'DONNELL
Suffix:
Gender:M
Credentials:DDS, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12106 SE 26TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-4119
Mailing Address - Country:US
Mailing Address - Phone:258-908-1834
Mailing Address - Fax:
Practice Address - Street 1:720 OLIVE WAY STE 810
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1836
Practice Address - Country:US
Practice Address - Phone:206-628-0404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60769832122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist