Provider Demographics
NPI:1386843886
Name:RALPH B WAUGH DDS MD INC
Entity Type:Organization
Organization Name:RALPH B WAUGH DDS MD INC
Other - Org Name:RALPH B WAUGH DDS MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:MR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:BEVERLY
Authorized Official - Last Name:WAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MD
Authorized Official - Phone:661-948-5061
Mailing Address - Street 1:43713 20TH ST W
Mailing Address - Street 2:SUITE #1
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534
Mailing Address - Country:US
Mailing Address - Phone:661-948-5061
Mailing Address - Fax:661-723-7390
Practice Address - Street 1:43713 20TH ST W
Practice Address - Street 2:#1
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534
Practice Address - Country:US
Practice Address - Phone:661-948-5061
Practice Address - Fax:661-723-7390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA14900OtherDENTAL
CA00A225240Medicaid
CAA84744Medicare UPIN
CA00A225240Medicaid