Provider Demographics
NPI:1831617968
Name:RAMIREZ, EDUARDO (LD)
Entity type:Individual
Prefix:
First Name:EDUARDO
Middle Name:
Last Name:RAMIREZ
Suffix:
Gender:M
Credentials:LD
Other - Prefix:
Other - First Name:EDUARDO
Other - Middle Name:
Other - Last Name:RAMIREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LD
Mailing Address - Street 1:696 NE WINCHESTER ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-3260
Mailing Address - Country:US
Mailing Address - Phone:541-673-2724
Mailing Address - Fax:
Practice Address - Street 1:696 NE WINCHESTER ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-3260
Practice Address - Country:US
Practice Address - Phone:541-673-2724
Practice Address - Fax:541-440-6906
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-08
Last Update Date:2017-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDT-DO-10185813122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist