Provider Demographics
NPI:1013465582
Name:RONALD K. RISINGER, DDS, MS, PC
Entity Type:Organization
Organization Name:RONALD K. RISINGER, DDS, MS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:RISINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-924-0002
Mailing Address - Street 1:228A COUNTRY LANE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:LUMBERTON
Mailing Address - State:TX
Mailing Address - Zip Code:77657
Mailing Address - Country:US
Mailing Address - Phone:409-751-2010
Mailing Address - Fax:
Practice Address - Street 1:228A COUNTRY LANE DR
Practice Address - Street 2:SUITE B
Practice Address - City:LUMBERTON
Practice Address - State:TX
Practice Address - Zip Code:77657
Practice Address - Country:US
Practice Address - Phone:409-751-2010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX15661OtherDENTAL LICENSE