Provider Demographics
NPI:1881709483
Name:MADDOX, RONALD LEE (DDS)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:LEE
Last Name:MADDOX
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 1:2623 LAUDER ROAD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77039-3119
Mailing Address - Country:US
Mailing Address - Phone:281-449-4439
Mailing Address - Fax:281-449-7224
Practice Address - Street 1:2623 LAUDER ROAD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77039-3119
Practice Address - Country:US
Practice Address - Phone:281-449-4439
Practice Address - Fax:281-449-7224
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11108122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist