Provider Demographics
NPI:1235209073
Name:ADAMS, RONALD M (DMD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:M
Last Name:ADAMS
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 1:708 DUNBAR RD
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-1002
Mailing Address - Country:US
Mailing Address - Phone:478-929-8622
Mailing Address - Fax:478-918-0253
Practice Address - Street 1:708 DUNBAR RD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-1002
Practice Address - Country:US
Practice Address - Phone:478-929-8622
Practice Address - Fax:478-918-0253
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA00100781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000297921GMedicaid
GA9182340OtherDORAL
GA100912OtherAVESIS