Provider Demographics
NPI:1538285887
Name:RONALD, JAMES B (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:B
Last Name:RONALD
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 1:75 CLAREMONT ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3585
Mailing Address - Country:US
Mailing Address - Phone:406-752-4375
Mailing Address - Fax:406-756-6471
Practice Address - Street 1:75 CLAREMONT ST
Practice Address - Street 2:SUITE D
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3585
Practice Address - Country:US
Practice Address - Phone:406-752-4375
Practice Address - Fax:406-756-6471
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT18791223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT12-0744Medicaid
MT12-0744Medicaid