Provider Demographics
NPI:1851952394
Name:THESIYA, RONAK HANSRAJBHAI (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONAK
Middle Name:HANSRAJBHAI
Last Name:THESIYA
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 1:742 W 27TH ST APT 26
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-3224
Mailing Address - Country:US
Mailing Address - Phone:215-450-0081
Mailing Address - Fax:
Practice Address - Street 1:4506 KOSTORYZ RD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78415-5023
Practice Address - Country:US
Practice Address - Phone:361-854-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35311122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty