Provider Demographics
NPI:1609898592
Name:CASDIN, RONALD CONWAY (DDS)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:CONWAY
Last Name:CASDIN
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 1:1799 N WATERMAN AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-5107
Mailing Address - Country:US
Mailing Address - Phone:909-886-4723
Mailing Address - Fax:909-886-4725
Practice Address - Street 1:1799 N WATERMAN AVE
Practice Address - Street 2:SUITE F
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-5107
Practice Address - Country:US
Practice Address - Phone:909-886-4723
Practice Address - Fax:909-886-4725
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22721122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist