Provider Demographics
NPI:1821022898
Name:FERMIN, RONALDO E (DMD)
Entity Type:Individual
Prefix:DR
First Name:RONALDO
Middle Name:E
Last Name:FERMIN
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 1:2400 WESTBOROUGH BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-5402
Mailing Address - Country:US
Mailing Address - Phone:650-878-1033
Mailing Address - Fax:650-878-1031
Practice Address - Street 1:2400 WESTBOROUGH BLVD STE 104
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-5402
Practice Address - Country:US
Practice Address - Phone:650-878-1033
Practice Address - Fax:650-878-1031
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA358801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice