Provider Demographics
NPI:1063545366
Name:MCENTIRE, RONALD GRAHAM (DDS)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:GRAHAM
Last Name:MCENTIRE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:R GRAHAM
Other - Middle Name:
Other - Last Name:MCENTIRE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1100 SOUTHGATE STE 3
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801
Mailing Address - Country:US
Mailing Address - Phone:541-276-5272
Mailing Address - Fax:541-276-7212
Practice Address - Street 1:1100 SOUTHGATE STE 3
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801
Practice Address - Country:US
Practice Address - Phone:541-276-5272
Practice Address - Fax:541-276-7212
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00007097122300000X
ORD103411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist