Provider Demographics
NPI:1104035096
Name:RODEN, RALPH DAVID JR (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:DAVID
Last Name:RODEN
Suffix:JR
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1771 INDEPENDENCE CT
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216-1258
Mailing Address - Country:US
Mailing Address - Phone:205-870-5834
Mailing Address - Fax:205-870-1618
Practice Address - Street 1:1771 INDEPENDENCE CT
Practice Address - Street 2:SUITE 2
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35216-1258
Practice Address - Country:US
Practice Address - Phone:205-870-5834
Practice Address - Fax:205-870-1618
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.28919204E00000X
AL52281223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery