Healthcare Provider Details

I. General information

NPI: 1386843886
Provider Name (Legal Business Name): RALPH B WAUGH DDS MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43713 20TH ST W #1
LANCASTER CA
93534
US

IV. Provider business mailing address

43713 20TH ST W SUITE #1
LANCASTER CA
93534
US

V. Phone/Fax

Practice location:
  • Phone: 661-948-5061
  • Fax: 661-723-7390
Mailing address:
  • Phone: 661-948-5061
  • Fax: 661-723-7390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MR. RALPH BEVERLY WAUGH
Title or Position: PRESIDENT OF CORPORATION
Credential: DDS MD
Phone: 661-948-5061