Provider Demographics
NPI:1164175238
Name:FOX, RONNIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONNIE
Middle Name:
Last Name:FOX
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:RONNIE
Other - Middle Name:CLAIRE
Other - Last Name:FOX PODKOVIK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:25929 CAMPO CV
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-6531
Mailing Address - Country:US
Mailing Address - Phone:773-814-6958
Mailing Address - Fax:
Practice Address - Street 1:5323 HARRY HINES BLVD.
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7201
Practice Address - Country:US
Practice Address - Phone:214-645-3979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-30
Last Update Date:2022-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program