Provider Demographics
NPI:1841536422
Name:TROSPER, RONALD WINSTON (DDS)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:WINSTON
Last Name:TROSPER
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 1:145 AVENIDA DEL MAR
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-4017
Mailing Address - Country:US
Mailing Address - Phone:949-492-7140
Mailing Address - Fax:949-492-2972
Practice Address - Street 1:145 AVENIDA DEL MAR
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-4017
Practice Address - Country:US
Practice Address - Phone:949-492-7140
Practice Address - Fax:949-492-2972
Is Sole Proprietor?:No
Enumeration Date:2012-12-30
Last Update Date:2012-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20478122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB20478-01Medicaid