Provider Demographics
NPI:1922116490
Name:RISNER, RONALD DALE (DDS)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:DALE
Last Name:RISNER
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 1:5930 E 31ST ST
Mailing Address - Street 2:STE 305
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-5111
Mailing Address - Country:US
Mailing Address - Phone:918-627-1717
Mailing Address - Fax:
Practice Address - Street 1:5930 E 31ST ST
Practice Address - Street 2:STE 305
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-5111
Practice Address - Country:US
Practice Address - Phone:918-627-1717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3603122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist