Provider Demographics
NPI:1083738488
Name:AUVENSHINE, RONALD CLARK (DDS, PHD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:CLARK
Last Name:AUVENSHINE
Suffix:
Gender:M
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7505 MAIN ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4520
Mailing Address - Country:US
Mailing Address - Phone:713-790-0531
Mailing Address - Fax:713-790-0725
Practice Address - Street 1:7505 MAIN ST
Practice Address - Street 2:SUITE 210
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4520
Practice Address - Country:US
Practice Address - Phone:713-790-0531
Practice Address - Fax:713-790-0725
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX96501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD09650Medicare UPIN