Provider Demographics
NPI:1265542112
Name:MCCAGHREN, RONNIE ALLEN (DMD)
Entity type:Individual
Prefix:DR
First Name:RONNIE
Middle Name:ALLEN
Last Name:MCCAGHREN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 FLINT RD SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-6025
Mailing Address - Country:US
Mailing Address - Phone:256-353-0832
Mailing Address - Fax:256-353-0876
Practice Address - Street 1:1906 FLINT RD SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-6025
Practice Address - Country:US
Practice Address - Phone:256-353-0832
Practice Address - Fax:256-353-0876
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL44491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice