Provider Demographics
NPI:1699079897
Name:GAMAN, RONALD FRANK (DMD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:FRANK
Last Name:GAMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 SW 10TH
Mailing Address - Street 2:SUITE 1212
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2713
Mailing Address - Country:US
Mailing Address - Phone:503-241-0077
Mailing Address - Fax:503-241-0077
Practice Address - Street 1:511 SW 10TH
Practice Address - Street 2:SUITE 1212
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2713
Practice Address - Country:US
Practice Address - Phone:503-241-0077
Practice Address - Fax:503-241-0077
Is Sole Proprietor?:No
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6168122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist