Provider Demographics
NPI:1043685357
Name:RONALD G DERIANA DDS PLLC
Entity Type:Organization
Organization Name:RONALD G DERIANA DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:DERIANA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:520-742-2167
Mailing Address - Street 1:1607 W INA RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1979
Mailing Address - Country:US
Mailing Address - Phone:520-742-2167
Mailing Address - Fax:520-742-2160
Practice Address - Street 1:1607 W INA RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1979
Practice Address - Country:US
Practice Address - Phone:520-742-2167
Practice Address - Fax:520-742-2160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDO3161261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental