Provider Demographics
NPI:1336333780
Name:RALPH B WAUGH DDS MD INC
Entity Type:Organization
Organization Name:RALPH B WAUGH DDS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:MR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:B
Authorized Official - Last Name:WAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MD
Authorized Official - Phone:661-948-5061
Mailing Address - Street 1:119 S GOLD CANYON
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555
Mailing Address - Country:US
Mailing Address - Phone:760-375-1511
Mailing Address - Fax:760-375-5980
Practice Address - Street 1:119 S GOLD CANYON
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555
Practice Address - Country:US
Practice Address - Phone:760-375-1511
Practice Address - Fax:760-375-5980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA149001223P0106X
CAA22524208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A22540Medicaid
CA14900OtherDENTAL
CA00A22540Medicaid