Provider Demographics
NPI:1053329680
Name:MCKAY, RONALD LEO (DDS)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:LEO
Last Name:MCKAY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 N CENTRAL AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1837
Mailing Address - Country:US
Mailing Address - Phone:818-242-4526
Mailing Address - Fax:
Practice Address - Street 1:607 N CENTRAL AVE STE 305
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1837
Practice Address - Country:US
Practice Address - Phone:818-242-4526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA541761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice