Healthcare Provider Details

I. General information

NPI: 1295850006
Provider Name (Legal Business Name): RONALD MAVIN GEORGESON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14941 W WHITESBRIDGE AVE
KERMAN CA
93630-1111
US

IV. Provider business mailing address

14941 W WHITESBRIDGE AVE
KERMAN CA
93630-1111
US

V. Phone/Fax

Practice location:
  • Phone: 559-846-6624
  • Fax: 559-272-5067
Mailing address:
  • Phone: 559-846-6624
  • Fax: 559-272-5067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number033090
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: