Provider Demographics
NPI:1932329356
Name:PAEZ, RONALD A (DDS)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:A
Last Name:PAEZ
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 1:8328 BEECHTREE WAY
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-4038
Mailing Address - Country:US
Mailing Address - Phone:818-908-4207
Mailing Address - Fax:
Practice Address - Street 1:6011 PACIFIC BLVD
Practice Address - Street 2:SUITE # 120
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-2951
Practice Address - Country:US
Practice Address - Phone:323-584-6777
Practice Address - Fax:323-583-2370
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD-41506122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist