Provider Demographics
NPI:1396937496
Name:LO, RONALD (DDS)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:
Last Name:LO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 SOUTH UNION AVE
Mailing Address - Street 2:BLDG B STE 12
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405
Mailing Address - Country:US
Mailing Address - Phone:253-383-1551
Mailing Address - Fax:253-383-5507
Practice Address - Street 1:2302 S UNION AVE
Practice Address - Street 2:BLDG B STE 12
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1300
Practice Address - Country:US
Practice Address - Phone:253-383-1551
Practice Address - Fax:253-383-5507
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA11080122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist