Provider Demographics
NPI:1811092604
Name:LORTS, RONALD ALYN (DMD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:ALYN
Last Name:LORTS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 W DAKOTA DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044
Mailing Address - Country:US
Mailing Address - Phone:480-893-7531
Mailing Address - Fax:480-893-7531
Practice Address - Street 1:3409 N 56TH ST
Practice Address - Street 2:#C
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-6150
Practice Address - Country:US
Practice Address - Phone:480-947-0663
Practice Address - Fax:480-947-6111
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ3526122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist