Provider Demographics
NPI:1083825343
Name:RONALD E HARRELL DDS PC
Entity Type:Organization
Organization Name:RONALD E HARRELL DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:229-524-5669
Mailing Address - Street 1:217 SOUTH WOOLFORK AVENUE
Mailing Address - Street 2:
Mailing Address - City:DONALSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:39845-1638
Mailing Address - Country:US
Mailing Address - Phone:229-524-5669
Mailing Address - Fax:229-524-6076
Practice Address - Street 1:217 SOUTH WOOLFORK AVENUE
Practice Address - Street 2:
Practice Address - City:DONALSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:39845-1638
Practice Address - Country:US
Practice Address - Phone:229-524-5669
Practice Address - Fax:229-524-6076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN006325122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty