Provider Demographics
NPI:1558334060
Name:RONALD K. EWERT, DDS, PC
Entity Type:Organization
Organization Name:RONALD K. EWERT, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:EWERT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:541-741-2252
Mailing Address - Street 1:750 N 14TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-4150
Mailing Address - Country:US
Mailing Address - Phone:541-741-2252
Mailing Address - Fax:541-741-7390
Practice Address - Street 1:750 N 14TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-4150
Practice Address - Country:US
Practice Address - Phone:541-741-2252
Practice Address - Fax:541-741-7390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD71901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty