Basic Information
Provider Information
NPI: 1255496972
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SABINS
FirstName: RONALD
MiddleName: ALLEN
NamePrefix: DR.
NameSuffix:  
Credential: DDS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6950 NE CAMPUS WAY
Address2:  
City: HILLSBORO
State: OR
PostalCode: 971245611
CountryCode: US
TelephoneNumber: 5039522164
FaxNumber: 5035264418
Practice Location
Address1: 3866 S 74TH ST
Address2: SUITE 200
City: TACOMA
State: WA
PostalCode: 984091045
CountryCode: US
TelephoneNumber: 8554336825
FaxNumber: 2537612732
Other Information
ProviderEnumerationDate: 12/22/2006
LastUpdateDate: 09/19/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223E0200XDE8575WAY Dental ProvidersDentistEndodontics
1223E0200XN-04265IDN Dental ProvidersDentistEndodontics

No ID Information.


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