Provider Demographics
NPI:1154314995
Name:WIHLIDAL, RONALD A (DDS)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:A
Last Name:WIHLIDAL
Suffix:
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 1:1616 N HARRISON ST
Mailing Address - Street 2:STE C
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-5642
Mailing Address - Country:US
Mailing Address - Phone:209-466-9661
Mailing Address - Fax:209-466-9664
Practice Address - Street 1:1616 N HARRISON ST
Practice Address - Street 2:STE C
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-5642
Practice Address - Country:US
Practice Address - Phone:209-466-9661
Practice Address - Fax:209-466-9664
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24620122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist