Provider Demographics
NPI:1225284912
Name:DYER, RONNIE LOUIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:RONNIE
Middle Name:LOUIS
Last Name:DYER
Suffix:
Gender:M
Credentials:DMD
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 1609
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30514-1609
Mailing Address - Country:US
Mailing Address - Phone:706-745-9621
Mailing Address - Fax:706-745-9622
Practice Address - Street 1:410 HARALSON PL
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-3087
Practice Address - Country:US
Practice Address - Phone:706-745-9621
Practice Address - Fax:706-745-9622
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA100231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice