Healthcare Provider Details

I. General information

NPI: 1013113414
Provider Name (Legal Business Name): RONALD OWEN DAVIES DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 05/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28241 CROWN VALLEY PKWY PMB 620 STE. F 620
LAGUNA NIGUEL CA
92677-4441
US

IV. Provider business mailing address

28241 CROWN VALLEY PKY PMB 620 STE F 620
LAGUNA NIGUEL CA
92677
US

V. Phone/Fax

Practice location:
  • Phone: 949-362-9690
  • Fax: 949-448-8858
Mailing address:
  • Phone: 949-362-9690
  • Fax: 949-448-8858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number24762
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: