Provider Demographics
NPI:1225180342
Name:SMITH, RONALD JAMES
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:JAMES
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 112
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER POINT
Mailing Address - State:VA
Mailing Address - Zip Code:23062-0112
Mailing Address - Country:US
Mailing Address - Phone:804-642-2120
Mailing Address - Fax:804-942-1804
Practice Address - Street 1:2630 GEORGE WASHINGTON MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:HAYES
Practice Address - State:VA
Practice Address - Zip Code:23072
Practice Address - Country:US
Practice Address - Phone:804-642-2120
Practice Address - Fax:804-642-1804
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010065921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice