Provider Demographics
NPI:1558681841
Name:ZEIDLER, RON ISSAC (DMD)
Entity Type:Individual
Prefix:DR
First Name:RON
Middle Name:ISSAC
Last Name:ZEIDLER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10231 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-6420
Mailing Address - Country:US
Mailing Address - Phone:310-552-2724
Mailing Address - Fax:310-552-1161
Practice Address - Street 1:10231 SANTA MONICA BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-6420
Practice Address - Country:US
Practice Address - Phone:310-552-2724
Practice Address - Fax:310-552-1161
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA381551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice