Provider Demographics
NPI:1033238837
Name:RJ RINGROSE DDS INC
Entity Type:Organization
Organization Name:RJ RINGROSE DDS INC
Other - Org Name:LAKESHORE DENTAL PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:RINGROSE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:707-994-6050
Mailing Address - Street 1:15322 LAKESHORE DRIVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CLEARLAKE
Mailing Address - State:CA
Mailing Address - Zip Code:95422
Mailing Address - Country:US
Mailing Address - Phone:707-994-6050
Mailing Address - Fax:707-994-8049
Practice Address - Street 1:15322 LAKESHORE DRIVE
Practice Address - Street 2:SUITE 104
Practice Address - City:CLEARLAKE
Practice Address - State:CA
Practice Address - Zip Code:95422
Practice Address - Country:US
Practice Address - Phone:707-994-6050
Practice Address - Fax:707-994-8049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA232371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty