Provider Demographics
NPI:1477545010
Name:SANI, RONALD JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:JAMES
Last Name:SANI
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 1:1705 N FINE AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-1616
Mailing Address - Country:US
Mailing Address - Phone:559-251-9466
Mailing Address - Fax:559-251-9498
Practice Address - Street 1:1705 N FINE AVE
Practice Address - Street 2:STE 102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-1616
Practice Address - Country:US
Practice Address - Phone:559-251-9466
Practice Address - Fax:559-251-9498
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD25207122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB25207-01OtherCA MEDICAL