Healthcare Provider Details

I. General information

NPI: 1982700423
Provider Name (Legal Business Name): RONALD E. PRICE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 04/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 HAYWARD DR.
MT VERNON MO
65712
US

IV. Provider business mailing address

1050 HAYWARD DR.
MT VERNON MO
65712
US

V. Phone/Fax

Practice location:
  • Phone: 417-466-7184
  • Fax:
Mailing address:
  • Phone: 417-466-7184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2007031864
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: