Provider Demographics
NPI:1659334217
Name:ALLISON, RONALD DAVID (DDS)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:DAVID
Last Name:ALLISON
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 1:322 N ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-2153
Mailing Address - Country:US
Mailing Address - Phone:760-728-1361
Mailing Address - Fax:760-728-6129
Practice Address - Street 1:322 N ORANGE AVE
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-2153
Practice Address - Country:US
Practice Address - Phone:760-728-1361
Practice Address - Fax:760-728-6129
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14711122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000822237OtherUNITED CONCORDIA
CAB-14711-01Medicaid