Provider Demographics
NPI:1336216365
Name:RONALD L CHALKER A PROFESSIONAL ORGANIZATION
Entity Type:Organization
Organization Name:RONALD L CHALKER A PROFESSIONAL ORGANIZATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHALKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-466-1243
Mailing Address - Street 1:7405 MORRO RD
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422
Mailing Address - Country:US
Mailing Address - Phone:805-466-1243
Mailing Address - Fax:805-466-7152
Practice Address - Street 1:7405 MORRO RD
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422
Practice Address - Country:US
Practice Address - Phone:805-466-1243
Practice Address - Fax:805-466-7152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24935122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty