Healthcare Provider Details

I. General information

NPI: 1467572131
Provider Name (Legal Business Name): RONALD ZIRKLE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16155 NW CORNELL RD SUITE 450
BEAVERTON OR
97006-4810
US

IV. Provider business mailing address

1101 SE TECH CENTER DR SUITE 195
VANCOUVER WA
98683-5504
US

V. Phone/Fax

Practice location:
  • Phone: 503-629-5300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberD8723
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: