Provider Demographics
NPI:1912965740
Name:WEISSMAN, RONALD STEPHEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:STEPHEN
Last Name:WEISSMAN
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 1:13843 N TATUM BLVD
Mailing Address - Street 2:STE 19
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-5545
Mailing Address - Country:US
Mailing Address - Phone:602-996-0988
Mailing Address - Fax:602-996-0975
Practice Address - Street 1:13843 N TATUM BLVD
Practice Address - Street 2:STE 19
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-5545
Practice Address - Country:US
Practice Address - Phone:602-996-0988
Practice Address - Fax:602-996-0975
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice