Provider Demographics
NPI:1336321108
Name:HASSELL, RALPH EUGENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:EUGENE
Last Name:HASSELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:GENE
Other - Middle Name:
Other - Last Name:HASSELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:200 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-2994
Mailing Address - Country:US
Mailing Address - Phone:512-251-7503
Mailing Address - Fax:512-251-7502
Practice Address - Street 1:200 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-2994
Practice Address - Country:US
Practice Address - Phone:512-251-7503
Practice Address - Fax:512-251-7502
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13627122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist