Provider Demographics
NPI:1831371699
Name:SHIRTCLIFF, RALPH MICHAEL (DMD)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:MICHAEL
Last Name:SHIRTCLIFF
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 490
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-0092
Mailing Address - Country:US
Mailing Address - Phone:888-468-0022
Mailing Address - Fax:541-504-3907
Practice Address - Street 1:244 NE DIVISION ST
Practice Address - Street 2:
Practice Address - City:MYRTLE CREEK
Practice Address - State:OR
Practice Address - Zip Code:97457-8507
Practice Address - Country:US
Practice Address - Phone:541-239-0009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4459122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR180968Medicaid