Provider Demographics
NPI: | 1982620571 |
---|---|
Name: | RONALD WM EARNEST DDS PC |
Entity Type: | Organization |
Organization Name: | RONALD WM EARNEST DDS PC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER DENTIST |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | RONALD |
Authorized Official - Middle Name: | WILLIAM |
Authorized Official - Last Name: | EARNEST |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DDS |
Authorized Official - Phone: | 810-229-2126 |
Mailing Address - Street 1: | 8086 GRAND RIVER |
Mailing Address - Street 2: | |
Mailing Address - City: | BRIGHTON |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 48114 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 810-229-2126 |
Mailing Address - Fax: | 810-229-4062 |
Practice Address - Street 1: | 8086 GRAND RIVER |
Practice Address - Street 2: | |
Practice Address - City: | BRIGHTON |
Practice Address - State: | MI |
Practice Address - Zip Code: | 48114 |
Practice Address - Country: | US |
Practice Address - Phone: | 810-229-2126 |
Practice Address - Fax: | 810-229-4062 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-07-15 |
Last Update Date: | 2007-10-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MI | 014627 | 1223G0001X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1223G0001X | Dental Providers | Dentist | General Practice | Group - Single Specialty |