Healthcare Provider Details

I. General information

NPI: 1376308114
Provider Name (Legal Business Name): RONALD E DUFFIN DDS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2024
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 E LATHAM AVE STE 2
HEMET CA
92543-4361
US

IV. Provider business mailing address

550 E LATHAM AVE STE 2
HEMET CA
92543-4361
US

V. Phone/Fax

Practice location:
  • Phone: 951-765-6232
  • Fax: 951-765-6235
Mailing address:
  • Phone: 951-765-6232
  • Fax: 951-765-6235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RONALD EUGENE DUFFIN
Title or Position: PRESIDENT
Credential: DDS
Phone: 951-765-6232