Provider Demographics
NPI:1366655714
Name:REDMOND, WILLIAM RONALD (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:RONALD
Last Name:REDMOND
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:DR
Other - First Name:W
Other - Middle Name:RONALD
Other - Last Name:REDMOND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:2410 S OLA VIS
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-4360
Mailing Address - Country:US
Mailing Address - Phone:714-349-8765
Mailing Address - Fax:949-528-0124
Practice Address - Street 1:INSTUDIO
Practice Address - Street 2:111 ACADEMY WAY SUITE 150
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92617-9261
Practice Address - Country:US
Practice Address - Phone:800-830-5686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS190041223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty