Provider Demographics
NPI:1255834610
Name:RONALD W HOUSEHOLDER DDS PLLC
Entity Type:Organization
Organization Name:RONALD W HOUSEHOLDER DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:HOUSEHOLDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:276-988-7522
Mailing Address - Street 1:PO BOX 542
Mailing Address - Street 2:
Mailing Address - City:NORTH TAZEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:24630-0542
Mailing Address - Country:US
Mailing Address - Phone:276-988-7522
Mailing Address - Fax:276-988-5866
Practice Address - Street 1:316 BEN BOLT AVE
Practice Address - Street 2:
Practice Address - City:TAZEWELL
Practice Address - State:VA
Practice Address - Zip Code:24651-5386
Practice Address - Country:US
Practice Address - Phone:276-988-7522
Practice Address - Fax:276-988-5866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401005792261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental