Healthcare Provider Details

I. General information

NPI: 1760634455
Provider Name (Legal Business Name): RONALD BAKER RAWLINS II D.M.D., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2008
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 SKYLINE DR SUITE 1
WILMINGTON DE
19808-1772
US

IV. Provider business mailing address

5500 SKYLINE DR SUITE 1
WILMINGTON DE
19808-1772
US

V. Phone/Fax

Practice location:
  • Phone: 484-467-5795
  • Fax:
Mailing address:
  • Phone: 484-467-5795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberG1-0001290
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: