Provider Demographics
NPI:1770523680
Name:WARREN, RONALD LEO (DDS)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:LEO
Last Name:WARREN
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 1:3011 DAWN DRIVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628
Mailing Address - Country:US
Mailing Address - Phone:512-863-7561
Mailing Address - Fax:512-863-7562
Practice Address - Street 1:3011 DAWN DRIVE
Practice Address - Street 2:SUITE 105
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628
Practice Address - Country:US
Practice Address - Phone:512-863-7561
Practice Address - Fax:512-863-7562
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119391223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice