Provider Demographics
NPI:1639157464
Name:HACKNEY, RONALD DEAN (DDS MS)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:DEAN
Last Name:HACKNEY
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5803 15TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-3006
Mailing Address - Country:US
Mailing Address - Phone:206-784-3740
Mailing Address - Fax:206-784-9869
Practice Address - Street 1:5803 15TH AVE NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3006
Practice Address - Country:US
Practice Address - Phone:206-784-3740
Practice Address - Fax:206-784-9869
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000075301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice