Provider Demographics
NPI:1013182344
Name:RONALD T MARSUURA
Entity Type:Organization
Organization Name:RONALD T MARSUURA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:T
Authorized Official - Last Name:MARSUURA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-354-1717
Mailing Address - Street 1:431 MONTEREY AVE #6
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030
Mailing Address - Country:US
Mailing Address - Phone:408-354-1717
Mailing Address - Fax:
Practice Address - Street 1:431 MONTEREY AVE #6
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030
Practice Address - Country:US
Practice Address - Phone:408-354-1717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty