Provider Demographics
NPI:1063497436
Name:MCFADDEN, RONDA L (DDS)
Entity Type:Individual
Prefix:
First Name:RONDA
Middle Name:L
Last Name:MCFADDEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:RONDA
Other - Middle Name:L
Other - Last Name:MCFADDEN-WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1123 E KANSAS PLZ
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-5870
Mailing Address - Country:US
Mailing Address - Phone:620-271-9200
Mailing Address - Fax:620-271-9205
Practice Address - Street 1:1123 E KANSAS PLZ
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-5870
Practice Address - Country:US
Practice Address - Phone:620-271-9200
Practice Address - Fax:620-271-9205
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7087122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100384860BMedicaid