Provider Demographics
NPI:1003008079
Name:CARR, RONALD J (DDS, MS, PC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:J
Last Name:CARR
Suffix:
Gender:M
Credentials:DDS, MS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4917 PLAZA AT PARKWAY
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762-4882
Mailing Address - Country:US
Mailing Address - Phone:432-362-4374
Mailing Address - Fax:432-367-6046
Practice Address - Street 1:4917 PLAZA AT PARKWAY
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-4882
Practice Address - Country:US
Practice Address - Phone:432-362-4374
Practice Address - Fax:432-367-6046
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX149091223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics