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NPI Code Detail

MEDICARE: DR. RONALD LEWIS PROCTOR DDS

MEDICARE: DR. RONALD LEWIS PROCTOR DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208D00000XGeneral Practice Physician10344TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CM76OTHERTXBCBS
2742084OTHERUNITED CONCORDIA

General Provider Information

NPI Number : 1881691459
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RONALD LEWIS PROCTOR DDS
Provider Business Mailing Address
First Line : 3740 N JOSEY LN
Second Line : STE 121
City : CARROLLTON
State : TX
Zip : 75007-2471
Country : US
Telephone Number : 972-492-2866
Fax Number : 972-394-0583
Provider Business Practice Location Address
First Line : 3740 N JOSEY LN
Second Line : STE 121
City : CARROLLTON
State : TX
Zip : 75007-2471
Country : US
Telephone Number : 972-492-2866
Fax Number : 972-394-0583
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2005
Last Update Date : 07/08/2007

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Directions to “ DR. RONALD LEWIS PROCTOR DDS” Practice Location

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