Provider Demographics
NPI:1124199351
Name:RONALD XAVIER DENTAL CORP
Entity Type:Organization
Organization Name:RONALD XAVIER DENTAL CORP
Other - Org Name:LONG BEACH DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:XAVIER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-436-4214
Mailing Address - Street 1:201 SANDPOINTE AVE
Mailing Address - Street 2:8TH FLOOR
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-5778
Mailing Address - Country:US
Mailing Address - Phone:562-436-4214
Mailing Address - Fax:562-435-3067
Practice Address - Street 1:308 ORANGE AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-3536
Practice Address - Country:US
Practice Address - Phone:562-436-4214
Practice Address - Fax:562-435-3067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA231551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty