Provider Demographics
NPI:1942311170
Name:FAIR, RONALD J (DDS, MPH)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:J
Last Name:FAIR
Suffix:
Gender:M
Credentials:DDS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1337 BANCROFT AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-5103
Mailing Address - Country:US
Mailing Address - Phone:510-351-2812
Mailing Address - Fax:510-351-2832
Practice Address - Street 1:1337 BANCROFT AVE
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-5103
Practice Address - Country:US
Practice Address - Phone:510-351-2812
Practice Address - Fax:510-351-2832
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA285441223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics