Provider Demographics
NPI:1992951305
Name:TRIBBLE, RONALD FORREST (DMD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:FORREST
Last Name:TRIBBLE
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:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:WINSTON
Mailing Address - State:OR
Mailing Address - Zip Code:97496-1239
Mailing Address - Country:US
Mailing Address - Phone:541-679-4179
Mailing Address - Fax:541-679-1402
Practice Address - Street 1:90 NW GLENHART
Practice Address - Street 2:
Practice Address - City:WINSTON
Practice Address - State:OR
Practice Address - Zip Code:97496
Practice Address - Country:US
Practice Address - Phone:541-679-4179
Practice Address - Fax:541-679-1402
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR65281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice