Provider Demographics
NPI:1083615819
Name:FENN, RONALD SAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:SAM
Last Name:FENN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1136 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-5008
Mailing Address - Country:US
Mailing Address - Phone:619-444-1181
Mailing Address - Fax:619-444-4552
Practice Address - Street 1:1136 N 2ND ST
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-5008
Practice Address - Country:US
Practice Address - Phone:619-444-1181
Practice Address - Fax:619-444-4552
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA209751223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics