Provider Demographics
NPI:1235263096
Name:ANDERSON, RONALD B (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:B
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 GRANVILLE ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-2967
Mailing Address - Country:US
Mailing Address - Phone:614-475-1874
Mailing Address - Fax:614-475-0812
Practice Address - Street 1:181 GRANVILLE ST
Practice Address - Street 2:SUITE 305
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-2967
Practice Address - Country:US
Practice Address - Phone:614-475-1874
Practice Address - Fax:614-475-0812
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH128271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice