Provider Demographics
NPI:1942345582
Name:RONALD K. RISINGER, DDS, MS, PC
Entity Type:Organization
Organization Name:RONALD K. RISINGER, DDS, MS, PC
Other - Org Name:GULF COAST ORTHODONTIC SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:RISINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:409-924-0002
Mailing Address - Street 1:3954 EASTEX FWY
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77703-1814
Mailing Address - Country:US
Mailing Address - Phone:409-924-0002
Mailing Address - Fax:409-924-0005
Practice Address - Street 1:3954 EASTEX FWY
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77703-1814
Practice Address - Country:US
Practice Address - Phone:409-924-0002
Practice Address - Fax:409-924-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX156611223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty