Provider Demographics
NPI:1891703732
Name:PROCTOR, RONALD HUGHES (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:HUGHES
Last Name:PROCTOR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:111 RAMPART BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW KENSINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15068-5629
Mailing Address - Country:US
Mailing Address - Phone:724-335-2862
Mailing Address - Fax:724-335-2283
Practice Address - Street 1:947 FOURTH AVE
Practice Address - Street 2:
Practice Address - City:NEW KENSINGTON
Practice Address - State:PA
Practice Address - Zip Code:15068-5629
Practice Address - Country:US
Practice Address - Phone:724-335-6166
Practice Address - Fax:724-335-6166
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019493L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA66721OtherUNISON
PA0512714Medicaid
PA099350OtherUNITED CONCORDIA
PA239701OtherGATEWAY
PA2223OtherDORAL