Provider Demographics
NPI:1568532430
Name:RHEUBEN, THOMAS ROY (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ROY
Last Name:RHEUBEN
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:PO BOX 2211
Mailing Address - Street 2:
Mailing Address - City:SISTERS
Mailing Address - State:OR
Mailing Address - Zip Code:97759-2211
Mailing Address - Country:US
Mailing Address - Phone:541-549-0109
Mailing Address - Fax:541-549-6915
Practice Address - Street 1:304 WEST ADAMS AVE.
Practice Address - Street 2:
Practice Address - City:SISTERS
Practice Address - State:OR
Practice Address - Zip Code:97759-2211
Practice Address - Country:US
Practice Address - Phone:541-549-0109
Practice Address - Fax:541-549-6915
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD66611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice