Provider Demographics
NPI:1891706099
Name:WORMSER, RONALD PHILIP (DMD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:PHILIP
Last Name:WORMSER
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 1:910 VIA DE LA PAZ
Mailing Address - Street 2:SUITE 108
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272
Mailing Address - Country:US
Mailing Address - Phone:310-454-3732
Mailing Address - Fax:310-459-2245
Practice Address - Street 1:910 VIA DE LA PAZ
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272
Practice Address - Country:US
Practice Address - Phone:310-454-3732
Practice Address - Fax:310-459-2245
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28832122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist