Provider Demographics
NPI:1346225117
Name:GUEST, RONNIE W (DDS)
Entity Type:Individual
Prefix:
First Name:RONNIE
Middle Name:W
Last Name:GUEST
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 1:401 EDGEMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-2314
Mailing Address - Country:US
Mailing Address - Phone:423-968-4114
Mailing Address - Fax:423-968-3477
Practice Address - Street 1:401 EDGEMONT AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-2314
Practice Address - Country:US
Practice Address - Phone:423-968-4114
Practice Address - Fax:423-968-3477
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice