Healthcare Provider Details

I. General information

NPI: 1578038931
Provider Name (Legal Business Name): DENTURE MASTERS OF EUGENE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2018
Last Update Date: 10/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 BAILEY HILL RD STE A
EUGENE OR
97405-1142
US

IV. Provider business mailing address

1925 BAILEY HILL RD STE A
EUGENE OR
97405-1142
US

V. Phone/Fax

Practice location:
  • Phone: 541-345-0004
  • Fax:
Mailing address:
  • Phone: 541-345-0004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. JAMES W RIDLEY
Title or Position: OWNER/ PRESIDENT
Credential: DDS, PC
Phone: 541-206-4524