Provider Demographics
NPI:1801839329
Name:MAXFIELD, RONALD ORIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:ORIN
Last Name:MAXFIELD
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 1:4476 W VAN GIESEN ST
Mailing Address - Street 2:
Mailing Address - City:WEST RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99353-5411
Mailing Address - Country:US
Mailing Address - Phone:509-967-3421
Mailing Address - Fax:509-967-2186
Practice Address - Street 1:4476 W VAN GIESEN ST
Practice Address - Street 2:
Practice Address - City:WEST RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99353-5411
Practice Address - Country:US
Practice Address - Phone:509-967-3421
Practice Address - Fax:509-967-2186
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5040845Medicaid