Provider Demographics
NPI:1134380355
Name:GEORGE, RONNIE (DDS)
Entity type:Individual
Prefix:DR
First Name:RONNIE
Middle Name:
Last Name:GEORGE
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 1:106 W UNIVERSITY PKWY
Mailing Address - Street 2:APT # L1
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-3432
Mailing Address - Country:US
Mailing Address - Phone:919-608-9189
Mailing Address - Fax:
Practice Address - Street 1:111 BATA BLVD STE D
Practice Address - Street 2:
Practice Address - City:BELCAMP
Practice Address - State:MD
Practice Address - Zip Code:21017-1427
Practice Address - Country:US
Practice Address - Phone:410-272-1536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD141871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice