Provider Demographics
NPI:1861604670
Name:BROWN, RONALD (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2376 SHADOW BERRY DR
Mailing Address - Street 2:P
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-5131
Mailing Address - Country:US
Mailing Address - Phone:209-815-9656
Mailing Address - Fax:
Practice Address - Street 1:132 SYCAMORE
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95222-1215
Practice Address - Country:US
Practice Address - Phone:209-823-2165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA142441223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics