Provider Demographics
NPI:1891348074
Name:RONALD L MOORE DDS INC
Entity Type:Organization
Organization Name:RONALD L MOORE DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-796-2299
Mailing Address - Street 1:25835 BARTON RD STE 104
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3898
Mailing Address - Country:US
Mailing Address - Phone:909-796-2299
Mailing Address - Fax:
Practice Address - Street 1:25835 BARTON RD STE 104
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3898
Practice Address - Country:US
Practice Address - Phone:909-796-2299
Practice Address - Fax:909-796-2509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty