Provider Demographics
NPI:1710045315
Name:HANCOCK, RONALD SAMMY (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:SAMMY
Last Name:HANCOCK
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 1:1302 RAGUET ST
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75961-4229
Mailing Address - Country:US
Mailing Address - Phone:936-564-7240
Mailing Address - Fax:936-564-2731
Practice Address - Street 1:1302 RAGUET ST
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4229
Practice Address - Country:US
Practice Address - Phone:936-564-7240
Practice Address - Fax:936-564-2731
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX197171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1710045315OtherNPI