Provider Demographics
NPI:1033250311
Name:RONALD B. MEAD, BRUCE L. WHITCHER, & ERIC M. ALLTUCKER, DDS
Entity type:Organization
Organization Name:RONALD B. MEAD, BRUCE L. WHITCHER, & ERIC M. ALLTUCKER, DDS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:B
Authorized Official - Last Name:MEAD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-541-3220
Mailing Address - Street 1:990 BOYSEN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-1313
Mailing Address - Country:US
Mailing Address - Phone:805-541-3220
Mailing Address - Fax:805-541-3704
Practice Address - Street 1:990 BOYSEN AVE
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-1313
Practice Address - Country:US
Practice Address - Phone:805-541-3220
Practice Address - Fax:805-541-3704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADB023450261QS0112X
CADX030128261QS0112X
CAD46732261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU17930Medicare UPIN
CAT79361Medicare UPIN