Provider Demographics
NPI:1083611206
Name:MAPLE, RONALD A (DMD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:A
Last Name:MAPLE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22135 NW IMBRIE DR
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-6988
Mailing Address - Country:US
Mailing Address - Phone:503-648-9878
Mailing Address - Fax:503-693-3918
Practice Address - Street 1:22135 NW IMBRIE DR
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-6988
Practice Address - Country:US
Practice Address - Phone:503-648-9878
Practice Address - Fax:503-693-3918
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD63321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice