Provider Demographics
NPI:1902965569
Name:DEXTER, DONALD RAY JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:RAY
Last Name:DEXTER
Suffix:JR
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 1:2911 TENNYSON AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408-4393
Mailing Address - Country:US
Mailing Address - Phone:541-844-1517
Mailing Address - Fax:541-844-1370
Practice Address - Street 1:2911 TENNYSON AVE STE 203
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97408-4393
Practice Address - Country:US
Practice Address - Phone:541-844-1517
Practice Address - Fax:541-844-1370
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6474122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist