Healthcare Provider Details

I. General information

NPI: 1487779732
Provider Name (Legal Business Name): RONALD WALTER JAWOR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5321 UNIVERSITY DR SUITE B
IRVINE CA
92612-2942
US

IV. Provider business mailing address

5321 UNIVERSITY DR SUITE B
IRVINE CA
92612-2942
US

V. Phone/Fax

Practice location:
  • Phone: 949-786-0777
  • Fax: 949-786-0508
Mailing address:
  • Phone: 949-786-0777
  • Fax: 949-786-0508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number23447
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: