Provider Demographics
NPI:1710945654
Name:CIVJAN, RALPH HAIME (DDS)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:HAIME
Last Name:CIVJAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:80 SUTTON PL
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-5757
Mailing Address - Country:US
Mailing Address - Phone:610-252-7681
Mailing Address - Fax:
Practice Address - Street 1:100 N 3RD ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-1869
Practice Address - Country:US
Practice Address - Phone:484-526-7330
Practice Address - Fax:610-250-2735
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY52568381223P0221X
PADS0374651223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry