Provider Demographics
NPI:1598869075
Name:DEDMOND, RONALD KEITH (DDS,PA)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:KEITH
Last Name:DEDMOND
Suffix:
Gender:M
Credentials:DDS,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 WOODVALE CIR
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-7712
Mailing Address - Country:US
Mailing Address - Phone:704-735-2963
Mailing Address - Fax:
Practice Address - Street 1:301 S ACADEMY ST
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-2716
Practice Address - Country:US
Practice Address - Phone:704-735-7001
Practice Address - Fax:704-735-7654
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4049122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1457375776OtherGROUP NPI NUMBER
NC8992085Medicaid