Provider Demographics
NPI:1124021522
Name:RANEY, ROBERT EWING JR (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:EWING
Last Name:RANEY
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 E HILDEBRAND AVE
Mailing Address - Street 2:STE 3
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-2476
Mailing Address - Country:US
Mailing Address - Phone:210-828-6357
Mailing Address - Fax:210-828-7460
Practice Address - Street 1:303 E HILDEBRAND AVE
Practice Address - Street 2:STE 3
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-2476
Practice Address - Country:US
Practice Address - Phone:210-828-6357
Practice Address - Fax:210-828-7460
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX670864OtherTRICARE PROVIDER ID
TX2364OtherGUARDIAN DMO PROVIDER ID
TX994823OtherCOMPDENT PROVIDER ID
TX26404OtherAETNA DMO PROVIDER ID