Provider Demographics
NPI:1295902682
Name:W. RONALD REDMOND DDS MS INC.
Entity type:Organization
Organization Name:W. RONALD REDMOND DDS MS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:REDMOND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:714-349-8765
Mailing Address - Street 1:2410 S OLA VIS
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-4360
Mailing Address - Country:US
Mailing Address - Phone:714-349-8765
Mailing Address - Fax:
Practice Address - Street 1:111 ACADEMY STE 150
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92617-3053
Practice Address - Country:US
Practice Address - Phone:714-349-8765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA447681223X0400X
1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty