Healthcare Provider Details

I. General information

NPI: 1821378142
Provider Name (Legal Business Name): RONALD J. LEVINE, D.M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2011
Last Update Date: 08/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 COUNTRY CLUB RD STE B
EUGENE OR
97401-2200
US

IV. Provider business mailing address

244 COUNTRY CLUB RD STE B
EUGENE OR
97401-2200
US

V. Phone/Fax

Practice location:
  • Phone: 541-686-2443
  • Fax: 541-302-0763
Mailing address:
  • Phone: 541-686-2443
  • Fax: 541-302-0763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number06549
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. RONALD JAMES LEVINE
Title or Position: PROSTHODONTIST
Credential: D.M.D.
Phone: 541-686-2443