Individual
RYAN DOUGLAS MCCORMICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
3620 SE POWELL BLVD STE 200, PORTLAND, OR 97202-1880
(503) 878-8702
(503) 878-8702
Mailing address
3620 SE POWELL BLVD STE 200, PORTLAND, OR 97202-1880
(503) 878-8702
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D11127
OR
Other
Enumeration date
09/06/2019
Last updated
09/06/2019
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