Provider Demographics
NPI:1831109925
Name:KOENIG, RONALD EUGENE (DMD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:EUGENE
Last Name:KOENIG
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 1:3315 SE HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-6586
Mailing Address - Country:US
Mailing Address - Phone:503-659-2357
Mailing Address - Fax:503-785-0342
Practice Address - Street 1:3315 SE HARRISON ST
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-6586
Practice Address - Country:US
Practice Address - Phone:503-659-2357
Practice Address - Fax:503-785-0342
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5688122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist