Provider Demographics
NPI:1477630739
Name:GHEEN, ROBERT LEE (D M D)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEE
Last Name:GHEEN
Suffix:
Gender:M
Credentials:D M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2216 BIRCHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4940
Mailing Address - Country:US
Mailing Address - Phone:541-343-7311
Mailing Address - Fax:
Practice Address - Street 1:927 COUNTRY CLUB RD
Practice Address - Street 2:SUITE 100
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2298
Practice Address - Country:US
Practice Address - Phone:541-683-0707
Practice Address - Fax:541-683-3309
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR48271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice