Provider Demographics
NPI:1609939461
Name:PARKIN, RONALD WAYNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:WAYNE
Last Name:PARKIN
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 1:16 RIVERBLUFF DR
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63019-1019
Mailing Address - Country:US
Mailing Address - Phone:636-933-0353
Mailing Address - Fax:
Practice Address - Street 1:2380 N TRUMAN BLVD
Practice Address - Street 2:
Practice Address - City:CRYSTAL CITY
Practice Address - State:MO
Practice Address - Zip Code:63019-1037
Practice Address - Country:US
Practice Address - Phone:636-937-9193
Practice Address - Fax:636-937-9194
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO13737122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist