Provider Demographics
NPI:1982759379
Name:FADAL, RONALD NELSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:NELSON
Last Name:FADAL
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 1:5 DOCTOR CIR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-5050
Mailing Address - Country:US
Mailing Address - Phone:903-758-6406
Mailing Address - Fax:903-758-8116
Practice Address - Street 1:5 DOCTOR CIR
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5050
Practice Address - Country:US
Practice Address - Phone:903-758-6406
Practice Address - Fax:903-758-8116
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX187841223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry