Provider Demographics
NPI:1801154778
Name:LEBUS, RONALD LAWRENCE (DDS)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:LAWRENCE
Last Name:LEBUS
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:P.O. BOX 5332
Mailing Address - Street 2:10A
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93921-5332
Mailing Address - Country:US
Mailing Address - Phone:831-624-8361
Mailing Address - Fax:
Practice Address - Street 1:SW CORNER OF LINCOLN AND 7TH AVE
Practice Address - Street 2:10A
Practice Address - City:CARMEL
Practice Address - State:CA
Practice Address - Zip Code:93921-5332
Practice Address - Country:US
Practice Address - Phone:831-624-8361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18366122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA18366OtherDENTISTRY