Provider Demographics
NPI:1376760819
Name:RISINGER, RONALD KEITH (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:KEITH
Last Name:RISINGER
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3190 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1420
Mailing Address - Country:US
Mailing Address - Phone:409-924-0002
Mailing Address - Fax:409-924-0005
Practice Address - Street 1:8 ACADIANA CT
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-3012
Practice Address - Country:US
Practice Address - Phone:409-899-4884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX156611223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX15661OtherDENTAL LICENSE