Provider Demographics
NPI:1922047745
Name:MORENO, RONALD A (DDS PS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:A
Last Name:MORENO
Suffix:
Gender:M
Credentials:DDS PS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3115 HOWE PL.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-1735
Mailing Address - Country:US
Mailing Address - Phone:360-676-0642
Mailing Address - Fax:360-676-1418
Practice Address - Street 1:3115 HOWE PL.
Practice Address - Street 2:SUITE 101
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-1735
Practice Address - Country:US
Practice Address - Phone:360-676-0642
Practice Address - Fax:360-676-1418
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 000075191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
57519OtherWDS INSURANCE NUMBER
WADE 00007519OtherWA STATE LICENSE
WA5021399OtherDSHS NUMBER
WA5021399OtherDSHS NUMBER
WADE 00007519OtherWA STATE LICENSE