Provider Demographics
NPI:1821378142
Name:RONALD J. LEVINE, D.M.D.
Entity Type:Organization
Organization Name:RONALD J. LEVINE, D.M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROSTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-686-2443
Mailing Address - Street 1:244 COUNTRY CLUB RD STE B
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2200
Mailing Address - Country:US
Mailing Address - Phone:541-686-2443
Mailing Address - Fax:541-302-0763
Practice Address - Street 1:244 COUNTRY CLUB RD STE B
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2200
Practice Address - Country:US
Practice Address - Phone:541-686-2443
Practice Address - Fax:541-302-0763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR065491223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty