Provider Demographics
NPI:1225257272
Name:DENT, RONALD J (EDD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:J
Last Name:DENT
Suffix:
Gender:M
Credentials:EDD
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 4883
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83711-4883
Mailing Address - Country:US
Mailing Address - Phone:208-376-1611
Mailing Address - Fax:208-658-1753
Practice Address - Street 1:335 ALLUMBAUGH ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9208
Practice Address - Country:US
Practice Address - Phone:208-376-1611
Practice Address - Fax:208-658-1753
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY-160106H00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDN6309OtherBLUE CROSS
ID000010160921OtherREGENCE BLUE SHIELD
ID000010160921OtherREGENCE BLUE SHIELD